Nursing Elites

1. A nurse is caring for a client with thrombocytopenia. Which action is the highest priority to reduce the risk of bleeding?

• A. Use an electric razor instead of a straight razor.
• B. Apply pressure to any bleeding sites for at least 5 minutes.
• C. Avoid invasive procedures unless absolutely necessary.
• D. Monitor for signs of internal bleeding.

Correct answer: C

Rationale: The highest priority action to reduce the risk of bleeding in a client with thrombocytopenia is to avoid invasive procedures unless absolutely necessary. Thrombocytopenia is a condition characterized by a low platelet count, which impairs the blood's ability to clot properly. By avoiding invasive procedures, the nurse minimizes the potential for bleeding episodes that could be challenging to control due to the low platelet count. Using an electric razor instead of a straight razor (Choice A) is a good practice to prevent cuts, but it is not as critical as avoiding invasive procedures in this scenario. Applying pressure to bleeding sites (Choice B) and monitoring for signs of internal bleeding (Choice D) are important interventions but are secondary to the priority of preventing bleeding by avoiding invasive procedures.

2. The nurse is assessing a client with leukemia who is receiving chemotherapy. Which of the following findings would be of most concern?

• A. Alopecia
• B. Fatigue
• C. Nausea and vomiting
• D. Mouth sores

Correct answer: D

Rationale: The correct answer is D, 'Mouth sores.' Mouth sores (stomatitis) are a common and potentially serious side effect of chemotherapy. They can lead to difficulty eating, increased risk of infection, and overall decreased quality of life for the client. While alopecia, fatigue, and nausea/vomiting are also common side effects of chemotherapy, they are generally manageable and do not pose the same level of immediate concern as the development of mouth sores in a client undergoing chemotherapy.

3. A nurse is caring for a patient with myelodysplastic syndrome (MDS) who is at risk for anemia. What is the most appropriate intervention to address this risk?

• A. Administering iron supplements
• B. Administering blood transfusions
• C. Providing a high-iron diet
• D. Administering erythropoietin

Correct answer: D

Rationale: In myelodysplastic syndrome (MDS), the bone marrow does not produce enough healthy blood cells, leading to conditions such as anemia. Administering erythropoietin is an effective intervention to manage anemia in MDS patients because it stimulates the production of red blood cells. This can help improve the patient’s hemoglobin levels, reducing symptoms such as fatigue and weakness associated with anemia. Erythropoietin is commonly used in MDS to enhance red blood cell production and reduce the need for frequent blood transfusions.

4. A 35-year-old male is admitted to the hospital complaining of severe headaches, vomiting, and testicular pain. His blood work shows reduced numbers of platelets, leukocytes, and erythrocytes, with a high proportion of immature cells. The nurse caring for this patient suspects a diagnosis of what?

• A. AML
• B. CML
• C. MDS
• D. ALL

Correct answer: D

Rationale: Acute Lymphocytic Leukemia (ALL) is a type of cancer where immature lymphocytes (a type of white blood cell) proliferate uncontrollably in the bone marrow. This leads to a reduction in the production of platelets, leukocytes, and erythrocytes, causing symptoms such as fatigue, anemia, bleeding tendencies, and increased susceptibility to infection. In ALL, leukemic cell infiltration into other organs is common, which can manifest as severe headaches (due to central nervous system involvement), vomiting, and testicular pain (due to infiltration of leukemic cells into the testes). These are hallmark signs of ALL, especially in younger patients.

5. The nurse is caring for a client following a mastectomy. Which nursing intervention would assist in preventing lymphedema of the affected arm?

• A. Placing cool compresses on the affected arm
• B. Elevating the affected arm on a pillow above heart level
• C. Avoiding arm exercises in the immediate postoperative period
• D. Maintaining an intravenous site below the antecubital area on the affected side

Correct answer: B

Rationale: After a mastectomy, particularly when lymph nodes are removed, there is an increased risk of lymphedema in the affected arm due to impaired lymphatic drainage. Elevating the affected arm above heart level helps promote lymphatic drainage and reduces the risk of swelling. This intervention facilitates the return of lymph fluid and helps prevent fluid accumulation in the arm.

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