Nursing Elites

1. A client with breast cancer is receiving doxorubicin (Adriamycin). The nurse monitors the client closely for:

• A. Pulmonary fibrosis
• B. Cardiotoxicity
• C. Hepatotoxicity
• D. Nephrotoxicity

Correct answer: B

Rationale: Doxorubicin (Adriamycin) is an anthracycline chemotherapy agent commonly used to treat various cancers, including breast cancer. One of the significant side effects associated with doxorubicin is cardiotoxicity, which can lead to serious complications such as heart failure and arrhythmias. The risk of cardiotoxicity is dose-dependent, meaning that higher cumulative doses increase the likelihood of cardiac damage. Therefore, it is essential for nurses to monitor cardiac function closely through assessments such as echocardiograms or monitoring for signs and symptoms of heart failure, such as shortness of breath, fatigue, and edema.

2. A nurse working with oncology clients knows that an age-related decrease in which function increases the older client’s susceptibility to infection during chemotherapy?

• A. Immune function.
• B. Kidney function.
• C. Liver function.
• D. Cardiac function.

Correct answer: A

Rationale: As people age, the immune system becomes less efficient, a phenomenon known as immunosenescence. This decline in immune function includes reduced production of immune cells (such as T cells and B cells) and diminished responses to infections. During chemotherapy, which further suppresses the immune system, older clients are at a significantly higher risk of developing infections due to this age-related decrease in immune function. This is especially concerning because chemotherapy targets rapidly dividing cells, which include immune cells, making it even harder for the body to fight off infections.

3. A patient diagnosed with polycythemia vera presents to the clinic for routine bloodwork. What should the nurse monitor for in this patient as a priority?

• A. Hemoglobin and hematocrit levels
• B. Platelet count
• C. White blood cell count
• D. Blood pressure

Correct answer: B

Rationale: In polycythemia vera, there is an overproduction of red blood cells, white blood cells, and platelets, which leads to increased blood viscosity and a high risk for thrombosis (blood clot formation). Monitoring the platelet count is a priority because elevated platelet levels contribute significantly to the risk of developing blood clots, which can result in life-threatening complications such as strokes, heart attacks, or deep vein thrombosis (DVT). Therefore, regular monitoring of the platelet count is essential to assess the patient’s risk for thrombosis and to guide treatment decisions, such as phlebotomy or medication adjustments to lower platelet levels.

4. The nurse is caring for a female client experiencing neutropenia as a result of chemotherapy and develops a plan of care for the client. The nurse plans to:

• A. Restrict all visitors
• B. Restrict fluid intake
• C. Teach the client and family about the need for hand hygiene
• D. Insert an indwelling urinary catheter to prevent skin breakdown

Correct answer: C

Rationale: In clients experiencing neutropenia due to chemotherapy, the immune system is significantly compromised, leaving the client highly susceptible to infections. Meticulous hand hygiene is one of the most effective ways to prevent infections in neutropenic patients. Teaching the client and their family the importance of frequent and proper handwashing helps reduce the transmission of harmful pathogens that could lead to severe infections in the neutropenic client. This simple but essential intervention is crucial in maintaining a safe environment.

5. Which of the following is considered correct in dealing with a patient who has gastric cancer?

• A. After total gastrectomy, patient will have to increase fluids during meals
• B. After total gastrectomy, patient will need lots of fiber in the diet
• C. After total gastrectomy, patient will have to walk about after meals
• D. After total gastrectomy, patient will have to lie flat on bed after meals

Correct answer: D

Rationale: After a total gastrectomy, where the entire stomach is removed, patients can experience dumping syndrome due to the rapid passage of food into the small intestine. This condition can lead to symptoms such as nausea, vomiting, diarrhea, and abdominal cramps. Lying flat after meals can help slow down the movement of food into the intestines, reducing the risk of dumping syndrome. It's important for patients to follow dietary recommendations and positioning strategies to manage symptoms effectively.

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