Nursing Elites

1. A gastrectomy is performed on a client with gastric cancer. In the immediate postoperative period, the nurse notes bloody drainage from the nasogastric tube. The nurse should take which most appropriate action?

• A. Measure abdominal girth.
• B. Irrigate the nasogastric tube.
• C. Continue to monitor the drainage.
• D. Notify the health care provider (HCP).

Correct answer: D

Rationale: In the immediate postoperative period following a gastrectomy, any bloody drainage from the nasogastric (NG) tube is concerning and requires prompt evaluation. This could indicate potential complications such as bleeding from the surgical site, erosion, or other postoperative issues. Notifying the healthcare provider immediately is crucial to ensure that the patient receives timely assessment and intervention. The presence of blood may necessitate further diagnostic procedures, interventions, or changes in management to prevent serious complications.

2. A nurse is planning care for a patient with leukemia who has been experiencing severe fatigue. What is the most appropriate intervention to include in the care plan?

• A. Encouraging the patient to remain in bed
• B. Scheduling frequent rest periods
• C. Providing a high-calorie diet
• D. Administering blood transfusions

Correct answer: B

Rationale: In patients with leukemia, severe fatigue is a common symptom due to factors such as anemia, the disease process itself, and the effects of treatments like chemotherapy. The most appropriate intervention is to schedule frequent rest periods to help manage fatigue while encouraging a balance between rest and activity. This approach allows the patient to conserve energy for essential tasks and prevent exhaustion, without promoting complete inactivity, which can lead to deconditioning.

3. A client receiving chemotherapy is experiencing severe nausea and vomiting. Which intervention should the nurse implement first?

• A. Administer antiemetics 30 minutes before chemotherapy.
• B. Offer small, frequent meals that are bland and easy to digest.
• C. Encourage the client to rest after meals to reduce nausea.
• D. Instruct the client to use relaxation techniques.

Correct answer: A

Rationale: The correct answer is A: Administer antiemetics 30 minutes before chemotherapy. Administering antiemetics before chemotherapy is crucial to prevent nausea rather than treating it after it occurs. This proactive approach helps in minimizing the side effects. Choice B, offering small, frequent meals, can be beneficial but is not the first intervention for severe nausea and vomiting. Choice C, encouraging rest after meals, may help but is not the priority when the client is experiencing severe symptoms. Choice D, instructing the client to use relaxation techniques, is not the first-line intervention for severe nausea and vomiting in a client receiving chemotherapy.

4. The nurse is monitoring a client for signs and symptoms related to superior vena cava syndrome. Which is an early sign of this oncological emergency?

• A. Cyanosis
• B. Arm edema
• C. Periorbital edema
• D. Mental status changes

Correct answer: C

Rationale: Superior vena cava syndrome (SVCS) occurs when the superior vena cava, the large vein that carries blood from the upper body to the heart, becomes compressed or obstructed, often by a tumor or enlarged lymph nodes, typically in cancers like lung cancer or lymphoma. The obstruction leads to increased venous pressure and reduced blood flow, resulting in swelling and edema in areas drained by the superior vena cava. Periorbital edema (swelling around the eyes) is one of the earliest signs of SVCS. This occurs because the impaired venous return causes fluid to accumulate in the soft tissues of the face, especially around the eyes. As the condition progresses, facial swelling can worsen, and other symptoms develop.

5. A client with cancer is admitted to a short-term rehabilitation facility. The nurse prepares to administer the client’s oral chemotherapy medications. What action by the nurse is most appropriate?

• A. Crush the medications if the client cannot swallow them.
• B. Give one medication at a time with a full glass of water.
• C. No special precautions are needed for these medications.
• D. Wear personal protective equipment when handling the medications.

Correct answer: D

Rationale: Oral chemotherapy requires the same precautions as IV chemotherapy; personal protective equipment is necessary.

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