Nursing Elites

1. A client with cancer has anorexia and mucositis, and is losing weight. The client’s family members continually bring favorite foods to the client and are distressed when the client won’t eat them. What action by the nurse is best?

• A. Explain the pathophysiologic reasons behind the client not eating.
• B. Help the family show other ways to demonstrate love and caring.
• C. Suggest foods and liquids the client might be willing to try to eat.
• D. Tell the family the client isn’t able to eat now no matter what they bring.

Correct answer: B

Rationale: The best action for the nurse in this situation is to help the family show other ways to demonstrate love and caring. When a client with cancer is experiencing anorexia and mucositis, it can be challenging for them to eat even their favorite foods. By assisting the family in finding alternative ways to provide comfort and care, the nurse can help create a supportive environment for the client. Option A is not the best choice as explaining the pathophysiologic reasons may not address the emotional needs of the client and family. Option C, suggesting foods and liquids, might not be helpful if the client is unable to tolerate them due to their condition. Option D, telling the family that the client can't eat, may come across as dismissive and not supportive of the family's concerns.

2. An oncology nurse educator is providing health education to a patient who has been diagnosed with skin cancer. The patient’s wife has asked about the differences between normal cells and cancer cells. What characteristic of a cancer cell should the educator cite?

• A. Malignant cells contain more fibronectin than normal body cells.
• B. Malignant cells contain proteins called tumor-specific antigens.
• C. Chromosomes contained in cancer cells are more durable and stable than those of normal cells.
• D. The nuclei of cancer cells are unusually large, but regularly shaped.

Correct answer: B

Rationale: Malignant (cancer) cells often express tumor-specific antigens (TSAs), which are proteins or markers on the surface of cancer cells that are not found on normal cells. These antigens are produced due to genetic mutations in cancer cells and can sometimes be used to help the immune system recognize and attack cancerous cells. Tumor-specific antigens play a key role in cancer diagnosis, monitoring, and targeted therapies.

3. A nurse is caring for a patient with myelodysplastic syndrome (MDS) who is receiving erythropoietin therapy. What should the nurse monitor to evaluate the effectiveness of this treatment?

• A. Platelet count
• B. Hemoglobin level
• C. White blood cell count
• D. Oxygen saturation

Correct answer: B

Rationale: Erythropoietin therapy is used to stimulate the production of red blood cells in patients with myelodysplastic syndrome (MDS), a disorder characterized by ineffective blood cell production, including red blood cells. The primary goal of erythropoietin therapy is to increase red blood cell count, improving the patient's oxygen-carrying capacity and reducing symptoms of anemia, such as fatigue and weakness. Monitoring hemoglobin levels is the best way to evaluate the effectiveness of this therapy because it directly reflects the patient's red blood cell count and the success of erythropoiesis (red blood cell production).

4. The nurse is developing a plan of care for the client with multiple myeloma and includes which priority intervention in the plan?

• A. Encouraging fluids
• B. Providing frequent oral care
• C. Coughing and deep breathing
• D. Monitoring the red blood cell count

Correct answer: A

Rationale: The correct answer is A: Encouraging fluids. In a client with multiple myeloma, encouraging fluids is a priority intervention to prevent kidney damage from high calcium levels. Adequate hydration helps maintain renal function and prevents complications. Providing frequent oral care (Choice B) is essential for clients at risk of mucositis or oral infections, such as those undergoing chemotherapy. Coughing and deep breathing exercises (Choice C) are commonly used for clients at risk of respiratory complications, like postoperative patients. Monitoring the red blood cell count (Choice D) is important for conditions like anemia but is not the priority in a client with multiple myeloma, where fluid management is crucial.

5. An oncology patient has just returned from the post-anesthesia care unit after an open hemicolectomy. This patient’s plan of nursing care should prioritize which of the following?

• A. Assess the patient hourly for signs of compartment syndrome.
• B. Assess the patient’s fine motor skills once per shift.
• C. Assess the patient’s wound for dehiscence every 4 hours.
• D. Maintain the patient’s head of bed at 45 degrees or more at all times.

Correct answer: C

Rationale: After an open hemicolectomy (surgical removal of part of the colon), monitoring the surgical wound for signs of dehiscence (wound reopening) is a critical nursing priority. Dehiscence is a serious postoperative complication that can occur if the surgical site does not heal properly. Regular wound assessments every 4 hours allow the nurse to identify early signs of complications, such as redness, swelling, increased drainage, or separation of the wound edges. Early detection is key to preventing further complications, such as infection or evisceration (protrusion of abdominal organs through the wound).

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