Nursing Elites

1. When educating a patient with multiple myeloma who is being discharged home, what should the nurse emphasize regarding the management of this condition?

• A. Increasing fluid intake
• B. Avoiding sunlight exposure
• C. Monitoring for signs of infection
• D. Managing pain

Correct answer: C

Rationale: The correct answer is C: Monitoring for signs of infection. Patients with multiple myeloma have a compromised immune system, making them more susceptible to infections. Emphasizing the importance of monitoring for signs of infection helps in early detection and prompt treatment. Increasing fluid intake (choice A) is essential for many health conditions but is not the priority in managing multiple myeloma. Avoiding sunlight exposure (choice B) may be relevant for certain skin conditions or medications but is not a key aspect of multiple myeloma management. Managing pain (choice D) is important, but in the context of multiple myeloma, monitoring for signs of infection takes precedence due to the increased risk of infections in these patients.

2. The nurse knows that all of the following are risk factors for breast cancer except:

• A. Family history
• B. Nulliparity
• C. Chest xray
• D. Multiple sex partners

Correct answer: D

Rationale: Multiple sex partners are not a recognized risk factor for breast cancer. Breast cancer is primarily influenced by hormonal, genetic, and environmental factors, not sexual activity or the number of sexual partners. Established risk factors for breast cancer include family history, hormonal factors such as early menarche, late menopause, and nulliparity (having no children), as well as certain environmental exposures.

3. An older adult patient is undergoing diagnostic testing for chronic lymphocytic leukemia (CLL). What assessment finding is certain to be present if the patient has CLL?

• A. Increased numbers of blast cells
• B. Increased lymphocyte levels
• C. Intractable bone pain
• D. Thrombocytopenia with no evidence of bleeding

Correct answer: B

Rationale: An increased lymphocyte count (lymphocytosis) is always present in patients with CLL.

4. A client has been prescribed epoetin alfa for anemia related to chemotherapy. What lab value should the nurse monitor to determine the effectiveness of this medication?

• A. Hemoglobin level.
• B. Hematocrit level.
• C. White blood cell count.
• D. Platelet count.

Correct answer: A

Rationale: Epoetin alfa is a medication used to treat anemia, particularly anemia related to chemotherapy or chronic kidney disease. It stimulates the bone marrow to produce more red blood cells, which increases the hemoglobin level. Monitoring hemoglobin is the best way to assess the effectiveness of epoetin alfa, as an increase in hemoglobin indicates that the body is producing more red blood cells and the anemia is improving.

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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