Nursing Elites

1. A client is receiving chemotherapy for the treatment of cancer. The nurse monitors the client for which of the following signs indicating a complication of the therapy?

• A. Alopecia
• B. Weight gain
• C. Elevated temperature
• D. Decreased hemoglobin level

Correct answer: C

Rationale: The correct answer is C: Elevated temperature. A fever may indicate infection, a common and serious complication of chemotherapy, requiring prompt intervention. Choice A, Alopecia, is a common side effect of chemotherapy but not a sign of a complication. Choice B, Weight gain, is not typically a sign of a complication of chemotherapy. Choice D, Decreased hemoglobin level, may occur due to chemotherapy but is not a direct sign of a complication.

2. A nurse is caring for a patient who has been diagnosed with leukemia. The nurse's most recent assessment reveals the presence of ecchymoses on the patient's sacral area and petechiae on her forearms. In addition to informing the patient's primary care provider, what action should the nurse take?

• A. Initiate measures to prevent venous thromboembolism (VTE).
• B. Check the patient's most recent platelet level.
• C. Place the patient on protective isolation.
• D. Ambulate the patient to promote circulatory function.

Correct answer: B

Rationale: The patient's signs of ecchymoses and petechiae are suggestive of thrombocytopenia, which is a common complication of leukemia. Thrombocytopenia is a condition characterized by a low platelet count, leading to abnormal bleeding. Checking the patient's most recent platelet level is crucial to assess the severity of thrombocytopenia and guide further interventions. Initiating measures to prevent venous thromboembolism (VTE) (Choice A) is not directly related to the patient's current signs. Placing the patient on protective isolation (Choice C) is not necessary for ecchymoses and petechiae. Ambulating the patient (Choice D) is not appropriate without addressing the underlying cause of abnormal bleeding.

3. The nurse is caring for a patient with an advanced stage of breast cancer and the patient has recently learned that her cancer has metastasized. The nurse enters the room and finds the patient struggling to breathe and the nurse’s rapid assessment reveals that the patient’s jugular veins are distended. The nurse should suspect the development of what oncologic emergency?

• A. Increased intracranial pressure
• B. Superior vena cava syndrome (SVCS)
• C. Spinal cord compression
• D. Metastatic tumor of the neck

Correct answer: B

Rationale: Superior vena cava syndrome (SVCS) occurs when the superior vena cava, the large vein responsible for returning blood from the upper body to the heart, becomes obstructed or compressed, often due to a tumor, such as metastasized breast cancer. SVCS results in impaired venous drainage, leading to symptoms like distended jugular veins, facial swelling, difficulty breathing (dyspnea), and upper body edema. It is a medical emergency that requires prompt intervention to restore blood flow and alleviate symptoms.

4. A patient with Hodgkin lymphoma is receiving chemotherapy. Which side effect is the nurse most concerned about?

• A. Nausea and vomiting
• B. Alopecia
• C. Fatigue
• D. Peripheral neuropathy

Correct answer: D

Rationale: The correct answer is D, Peripheral neuropathy. This can be a serious and dose-limiting side effect of chemotherapy for Hodgkin lymphoma. Peripheral neuropathy can cause tingling, numbness, and pain in the hands and feet due to nerve damage. While nausea and vomiting, alopecia, and fatigue are common side effects of chemotherapy, they are not typically as concerning or dose-limiting as peripheral neuropathy in the context of Hodgkin lymphoma treatment.

5. While a patient is receiving IV doxorubicin hydrochloride for the treatment of cancer, the nurse observes swelling and pain at the IV site. The nurse should prioritize what action?

• A. Stopping the administration of the drug immediately
• B. Notifying the patient's physician
• C. Continuing the infusion but decreasing the rate
• D. Applying a warm compress to the infusion site

Correct answer: A

Rationale: The correct action for the nurse to take when observing swelling and pain at the IV site during the administration of doxorubicin hydrochloride is to stop the administration of the drug immediately. Doxorubicin hydrochloride can cause severe tissue damage, so discontinuing the infusion is crucial to prevent further harm to the patient. Notifying the physician is important, but it should not take precedence over stopping the drug. Continuing the infusion, even at a decreased rate, can exacerbate tissue damage. Applying a warm compress is not appropriate in this situation and may worsen the tissue injury caused by the drug.

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