Nursing Elites

1. A nurse works with clients who have alopecia from chemotherapy. What action by the nurse takes priority?

• A. Helping clients adjust to their appearance.
• B. Reassuring clients that this change is temporary.
• C. Referring clients to a reputable wig shop.
• D. Teaching measures to prevent scalp injury.

Correct answer: D

Rationale: The correct answer is D: Teaching measures to prevent scalp injury. Alopecia makes the scalp more vulnerable to injury, so educating clients on protective measures is crucial. Choices A and B focus on emotional support and reassurance, which are important but secondary to physical safety. Referring clients to a wig shop (choice C) addresses appearance but does not directly address the physical risk associated with scalp vulnerability.

2. A patient with chronic lymphocytic leukemia (CLL) is at risk for tumor lysis syndrome. What laboratory values should the nurse monitor to detect this complication?

• A. Creatinine and blood urea nitrogen (BUN)
• B. Electrolytes and uric acid levels
• C. Serum glucose and calcium levels
• D. Liver enzymes and bilirubin levels

Correct answer: B

Rationale: Electrolytes and uric acid levels are important to monitor for the development of tumor lysis syndrome.

3. 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.

4. Nurse Joy is caring for a client with cancer who has been receiving cisplatin (Platinol-AQ). Which laboratory result requires an intervention by the nurse?

• A. White blood cell count of 6000 cells/microL
• B. Serum potassium level of 3.5 mEq/L
• C. Blood urea nitrogen (BUN) of 18 mg/dL
• D. Platelet count of 150,000 cells/microL

Correct answer: C

Rationale: The correct answer is C. A BUN level of 18 mg/dL is within the normal range; however, since cisplatin is nephrotoxic, it requires close monitoring. Elevated BUN levels can indicate impaired kidney function. Choices A, B, and D are within normal ranges and do not directly relate to cisplatin therapy or require immediate intervention.

5. A patient with multiple myeloma has developed hypercalcemia. What symptoms should the nurse monitor for in this patient?

• A. Increased heart rate
• B. Decreased urine output
• C. Muscle weakness
• D. Hypertension

Correct answer: C

Rationale: The correct answer is C: Muscle weakness. In patients with multiple myeloma who have developed hypercalcemia, monitoring for muscle weakness is crucial. Hypercalcemia can lead to muscle weakness due to its effects on neuromuscular function. Choice A, increased heart rate, is more commonly associated with conditions like dehydration or anxiety rather than hypercalcemia. Choice B, decreased urine output, is commonly seen in conditions leading to acute kidney injury rather than hypercalcemia. Choice D, hypertension, is not a typical symptom of hypercalcemia and is more commonly associated with other conditions like uncontrolled high blood pressure.

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