Nursing Elites

1. 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.

2. The cells of a normal individual can replicate in a specified rate. If the rate of replication becomes uncontrollable, which of the following is lacking from the patient?

• A. Apoptosis
• B. Contact inhibition
• C. Stable cells
• D. Labile cells

Correct answer: B

Rationale: Contact inhibition is a regulatory mechanism that prevents cells from proliferating once they reach a certain density. Normally, when cells grow and touch each other (such as in a monolayer), they stop dividing, maintaining tissue integrity and structure. When contact inhibition is lacking, as in many cancerous cells, cells continue to grow and divide uncontrollably, leading to tumor formation. This loss of regulation is a hallmark of cancerous growth.

3. Nurse Mike is providing care to a client with chronic myelogenous leukemia (CML). The nurse knows that the client is at risk for tumor lysis syndrome. Which of the following laboratory values requires immediate intervention?

• A. Increased uric acid level
• B. Increased serum potassium level
• C. Increased serum sodium level
• D. Increased fibrinogen level

Correct answer: A

Rationale: The correct answer is A: Increased uric acid level. In tumor lysis syndrome, rapid cell destruction releases large amounts of potassium, phosphate, and nucleic acids into the bloodstream. Uric acid can accumulate rapidly, leading to hyperuricemia, which can result in kidney damage due to urate crystal deposition. Immediate intervention is necessary to prevent renal complications. Choices B, C, and D are incorrect because while electrolyte imbalances are common in tumor lysis syndrome, hyperuricemia with potential kidney damage is the priority concern that requires immediate attention.

4. A client is diagnosed with multiple myeloma and the client asks the nurse about the diagnosis. The nurse bases the response on which description of this disorder?

• A. Altered red blood cell production
• B. Altered production of lymph nodes
• C. Malignant exacerbation in the number of leukocytes
• D. Malignant proliferation of plasma cells within the bone

Correct answer: D

Rationale: Multiple myeloma is a type of cancer that involves the malignant proliferation of plasma cells, which are a type of white blood cell that produces antibodies. In multiple myeloma, these abnormal plasma cells accumulate in the bone marrow, where they interfere with the production of normal blood cells and lead to the formation of tumors in the bones. This can cause bone pain, fractures, anemia, and impaired immune function. The excessive production of abnormal antibodies can also result in kidney damage and other systemic complications.

5. When preparing for the patient's subsequent care after completing the full course of treatment for acute lymphocytic leukemia without a significant response, what action should the nurse take?

• A. Arrange a meeting between the patient's family and the hospital chaplain.
• B. Assess the factors underlying the patient's failure to adhere to the treatment regimen.
• C. Encourage the patient to vigorously pursue complementary and alternative medicine (CAM).
• D. Identify the patient's specific wishes around end-of-life care.

Correct answer: D

Rationale: In cases where a patient does not respond appreciably to therapy, it is crucial to identify and respect the patient's choices regarding treatment, including preferences for end-of-life care. Option A is incorrect because it focuses on spiritual support rather than the patient's care preferences. Option B is incorrect as it assumes non-adherence to treatment without evidence. Option C is incorrect as it suggests an alternative treatment approach without considering the patient's wishes for end-of-life care.

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