Nursing Elites

1. A clinic nurse is working with a patient who has a long-standing diagnosis of polycythemia vera. How can the nurse best gauge the course of the patient's disease?

• A. Document the color of the patient's palms and face during each visit.
• B. Follow the patient's erythrocyte sedimentation rate over time.
• C. Document the patient's response to erythropoietin injections.
• D. Follow the trends of the patient's hematocrit.

Correct answer: D

Rationale: The course of polycythemia vera can be best ascertained by monitoring the patient's hematocrit, which should remain below 45%. Hematocrit levels are a key indicator in assessing the progression of the disease. Choices A, B, and C are not the most appropriate methods for gauging the course of polycythemia vera. Monitoring the color of the patient's palms and face, or their response to erythropoietin injections, may not provide an accurate reflection of the disease's progression. Similarly, while erythrocyte sedimentation rate can be affected in polycythemia vera, it is not the primary marker for monitoring the disease's course.

2. The nurse is caring for a 39-year-old woman with a family history of breast cancer. She requested a breast tumor marking test and the results have come back positive. As a result, the patient is requesting a bilateral mastectomy. This surgery is an example of what type of oncologic surgery?

• A. Salvage surgery
• B. Palliative surgery
• C. Prophylactic surgery
• D. Reconstructive surgery

Correct answer: C

Rationale: Prophylactic surgery refers to the preventive removal of tissues or organs at high risk for developing cancer, even when no cancer is currently present. In this case, the patient has a positive breast tumor marking test and a significant family history of breast cancer, which places her at increased risk for developing the disease. A bilateral mastectomy is performed to significantly reduce this risk by removing both breasts, thereby preventing the potential future occurrence of breast cancer.

3. The community health nurse is instructing a group of young female clients about breast self-examination. The nurse should instruct the clients to perform the examination at which time?

• A. At the onset of menstruation
• B. Every month during ovulation
• C. Weekly at the same time of day
• D. 1 week after menstruation begins

Correct answer: D

Rationale: The optimal time for performing a breast self-examination (BSE) is about one week after menstruation begins, as this is when the breasts are least likely to be swollen, tender, or affected by hormonal changes. Hormonal fluctuations during the menstrual cycle can cause temporary changes in breast tissue, such as swelling, lumpiness, or tenderness, which may make it more difficult to detect any unusual lumps or changes. Conducting the examination during this period ensures that the breasts are in their natural state, making it easier to notice any abnormalities.

4. 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.

5. Nurse Rose is caring for a client with cancer who has developed spinal cord compression. Which of the following symptoms would the nurse expect to find?

• A. Decreased deep tendon reflexes
• B. Severe headache
• C. Back pain
• D. Loss of bladder control

Correct answer: C

Rationale: The correct answer is C: 'Back pain.' Back pain is a common symptom of spinal cord compression in cancer patients. This condition can cause localized or radiating back pain due to the compression of the spinal cord or nerves. While symptoms such as decreased deep tendon reflexes, severe headache, and loss of bladder control can occur in other conditions, back pain is specifically associated with spinal cord compression in cancer patients.

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