Nursing Elites

1. A patient admitted with cancer asks the nurse about the difference between chemotherapy and radiation therapy. Which of the following responses by the nurse indicates a need for further teaching?

• A. Chemotherapy kills cancer cells
• B. Radiation therapy can be internal or external
• C. Radiation therapy is often external
• D. Chemotherapy is more likely to kill normal cells

Correct answer: D

Rationale: While chemotherapy does affect normal, healthy cells—particularly those that divide rapidly—it is not "more likely" to kill normal cells compared to cancer cells. Chemotherapy targets rapidly dividing cells, which includes both cancer cells and some normal cells (like those in hair follicles, the gastrointestinal tract, and bone marrow). However, its primary goal is to kill cancer cells, and its effects on normal cells are a side effect, not the main function. Therefore, the statement that chemotherapy is "more likely" to kill normal cells is inaccurate and indicates a need for further teaching.

2. A patient’s most recent diagnostic imaging has revealed that his lung cancer has metastasized to his bones and liver. What is the most likely mechanism by which the patient’s cancer cells spread?

• A. Hematologic spread
• B. Lymphatic circulation
• C. Invasion
• D. Angiogenesis

Correct answer: B

Rationale: In the case of lung cancer that has metastasized to the bones and liver, lymphatic circulation is a key mechanism by which cancer cells spread from the primary tumor site to distant organs. Cancer cells can invade nearby lymphatic vessels and travel through the lymphatic system, eventually reaching lymph nodes and spreading to other tissues and organs. This route is significant in the metastasis of many types of cancer, including lung cancer.

3. A patient with acute lymphocytic leukemia (ALL) is undergoing chemotherapy and develops neutropenia. What is the most important nursing intervention for this patient?

• A. Administering antipyretics
• B. Restricting visitors
• C. Maintaining a sterile environment
• D. Administering prophylactic antibiotics

Correct answer: C

Rationale: Maintaining a sterile environment is crucial to prevent infection in neutropenic patients.

4. A 16-year-old female patient experiences alopecia resulting from chemotherapy, prompting the nursing diagnoses of disturbed body image and situational low self-esteem. What action by the patient would best indicate that she is meeting the goal of improved body image and self-esteem?

• A. The patient requests that her family bring her makeup and wig.
• B. The patient begins to discuss the future with her family.
• C. The patient reports less disruption from pain and discomfort.
• D. The patient cries openly when discussing her disease.

Correct answer: A

Rationale: When a patient experiences alopecia due to chemotherapy, it can significantly impact their self-esteem and body image, particularly in adolescents who are especially sensitive to physical changes. A request for makeup and a wig indicates that the patient is actively taking steps to enhance her appearance and cope with the changes brought on by her treatment. This action reflects a positive engagement with her body image and suggests a desire to feel more comfortable and confident in her appearance, signaling an improvement in her self-esteem.

5. Four clients are receiving tyrosine kinase inhibitors (TKIs). Which of these four clients would the nurse assess first?

• A. Dry, itchy, peeling skin.
• B. Serum calcium of 9.2 mg/dL (2.3 mmol/L).
• C. Serum potassium of 2.8 mEq/L (2.8 mmol/L).
• D. Weight gain of 0.5 lb (1.1 kg) in 1 day.

Correct answer: C

Rationale: A potassium level of 2.8 mEq/L is critically low and requires immediate intervention.

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