Nursing Elites

1. A nurse provides care on a bone marrow transplant unit and is preparing a female patient for a hematopoietic stem cell transplantation (HSCT) the following day. What information should the nurse emphasize to the patient’s family and friends?

• A. Your family should gather at the bedside in case there is a negative outcome.
• B. Ensure she abstains from eating any food 24 hours before the procedure.
• C. Wear a hospital gown when entering the patient's room.
• D. Avoid visiting if you've had a recent infection.

Correct answer: D

Rationale: The correct answer is D: 'Avoid visiting if you've had a recent infection.' Before a hematopoietic stem cell transplantation, it is essential for visitors to refrain from visiting if they have had a recent illness or vaccination to minimize the risk of infection to the patient. Choice A is incorrect because emphasizing a negative outcome is not beneficial to the patient or their family. Choice B is incorrect as it is not necessary to abstain from food for a hematopoietic stem cell transplantation. Choice C is irrelevant to the situation as wearing a hospital gown is not the key information for family and friends to be aware of.

2. 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.

3. A nursing student is caring for a patient with acute myeloid leukemia who is preparing to undergo induction therapy. In preparing a plan of care for this patient, the student should assign the highest priority to which nursing diagnosis?

• A. Activity Intolerance
• B. Risk for Infection
• C. Acute Confusion
• D. Risk for Spiritual Distress

Correct answer: B

Rationale: The correct answer is B: Risk for Infection. Induction therapy for acute myeloid leukemia suppresses the immune system, making the patient highly susceptible to infections due to neutropenia. Preventing infections is crucial in these patients to avoid complications. Activity Intolerance (Choice A) may be a concern, but infection prevention is of higher priority. Acute Confusion (Choice C) and Risk for Spiritual Distress (Choice D) are not the immediate priorities in this situation.

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. Which of the following is not a manifestation of breast cancer?

• A. Peau d'orange
• B. Painless breast mass
• C. Alopecia
• D. Breast enlargement

Correct answer: C

Rationale: Alopecia (hair loss) is not a direct manifestation of breast cancer but rather a common side effect of chemotherapy used in breast cancer treatment. Peau d'orange refers to the dimpling or pitting of the skin resembling an orange peel, which can be a sign of breast cancer due to blockage of lymphatic vessels. A painless breast mass and breast enlargement can both be manifestations of breast cancer, with a painless mass being a common symptom and breast enlargement sometimes occurring due to tumor growth.

Similar Questions