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. An oncology patient will begin a course of chemotherapy and radiation therapy for the treatment of bone metastases. What is one means by which malignant disease processes transfer cells from one place to another?

• A. Adhering to primary tumor cells
• B. Inducing mutation of cells of another organ
• C. Phagocytizing healthy cells
• D. Invading healthy host tissues

Correct answer: D

Rationale: The correct answer is D: Invading healthy host tissues. Invasion is the process where malignant cells grow into surrounding healthy tissues, allowing the cancer to spread to other parts of the body. Choices A, B, and C are incorrect. Adhering to primary tumor cells does not involve the transfer of cells to other locations, inducing mutation of cells of another organ is not a mechanism of cell transfer, and phagocytizing healthy cells refers to the process of engulfing and digesting cells, which is not a method of cancer cell transfer.

3. Nurse Kate is reviewing the complications of conization with a client who has microinvasive cervical cancer. Which complication, if identified by the client, indicates a need for further teaching?

• A. Infection
• B. Hemorrhage
• C. Cervical stenosis
• D. Ovarian perforation

Correct answer: D

Rationale: The correct answer is D, 'Ovarian perforation.' Ovarian perforation is not a complication associated with conization; therefore, if the client identifies this as a potential complication, it indicates a need for further teaching. Choices A, B, and C are incorrect: Infection, hemorrhage, and cervical stenosis are potential complications of conization, so identifying them would not necessarily indicate a need for further teaching.

4. A nurse practitioner is assessing a patient who has a fever, malaise, and a white blood cell count that is elevated. Which of the following principles should guide the nurses management of the patients care?

• A. There is a need for the patient to be assessed for lymphoma.
• B. Infection is the most likely cause of the patients change in health status.
• C. The patient is exhibiting signs and symptoms of leukemia.
• D. The patient should undergo diagnostic testing for multiple myeloma.

Correct answer: B

Rationale: An elevated white blood cell (WBC) count, also known as leukocytosis, is most commonly a response to infection. When the body detects an infection, the immune system responds by increasing the production of white blood cells to fight off the invading pathogens. The accompanying symptoms of fever and malaise are typical signs of infection, supporting the likelihood that this patient’s health status is related to an infectious process rather than a more serious hematologic condition like lymphoma or leukemia.

5. A patient with myelofibrosis is being treated with ruxolitinib. What should the nurse monitor to assess the effectiveness of this treatment?

• A. Blood pressure
• B. White blood cell count
• C. Hemoglobin and hematocrit
• D. Spleen size

Correct answer: C

Rationale: Monitoring hemoglobin and hematocrit is essential to assess the effectiveness of ruxolitinib in treating myelofibrosis. Ruxolitinib works by inhibiting JAK1 and JAK2, which are involved in the signaling pathways that regulate blood cell production. Therefore, monitoring hemoglobin and hematocrit levels can provide valuable information on how well the drug is managing the disease. Blood pressure, white blood cell count, and spleen size are not direct indicators of the treatment's effectiveness in myelofibrosis.

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