Nursing Elites

1. A patient diagnosed with polycythemia vera presents to the clinic for routine bloodwork. What should the nurse monitor for in this patient as a priority?

• A. Hemoglobin and hematocrit levels
• B. Platelet count
• C. White blood cell count
• D. Blood pressure

Correct answer: B

Rationale: In polycythemia vera, there is an overproduction of red blood cells, white blood cells, and platelets, which leads to increased blood viscosity and a high risk for thrombosis (blood clot formation). Monitoring the platelet count is a priority because elevated platelet levels contribute significantly to the risk of developing blood clots, which can result in life-threatening complications such as strokes, heart attacks, or deep vein thrombosis (DVT). Therefore, regular monitoring of the platelet count is essential to assess the patient’s risk for thrombosis and to guide treatment decisions, such as phlebotomy or medication adjustments to lower platelet levels.

2. A 58-year-old male patient has been hospitalized for a wedge resection of the left lower lung lobe after a routine chest x-ray shows carcinoma. The patient is anxious and asks if he can smoke. Which statement by the nurse would be most therapeutic?

• A. Smoking is the reason you are here.
• B. The doctor left orders for you not to smoke.
• C. You are anxious about the surgery. Do you see smoking as helping?
• D. Smoking is OK right now, but after your surgery it is contraindicated.

Correct answer: C

Rationale: Choice C is the most therapeutic response as it acknowledges the patient's anxiety and encourages reflection on his behavior. This approach can help the patient explore his feelings and thoughts about smoking in relation to his surgery, promoting self-awareness and potentially opening the door for a constructive discussion. Choices A and B are more directive and may not address the underlying anxiety and need for reflection. Choice D is also somewhat permissive about smoking before surgery, which may not be in the patient's best interest.

3. A nurse is caring for a patient diagnosed with essential thrombocythemia (ET) who is at risk for thromboembolic events. What nursing intervention is most appropriate for this patient?

• A. Encouraging regular physical activity
• B. Administering anticoagulant therapy
• C. Monitoring for signs of bleeding
• D. Monitoring for signs of infection

Correct answer: B

Rationale: Administering anticoagulant therapy is crucial to prevent thromboembolic events in patients with ET.

4. A nurse who works in an oncology clinic is assessing a patient who has arrived for a 2-month follow-up appointment following chemotherapy. The nurse notes that the patient's skin appears yellow. Which blood tests should be done to further explore this clinical sign?

• A. Liver function tests (LFTs)
• B. Complete blood count (CBC)
• C. Platelet count
• D. Blood urea nitrogen and creatinine

Correct answer: A

Rationale: Corrected Detailed Rationale: Yellow skin is a sign of jaundice, which is often associated with liver disease. Liver function tests (LFTs) help in evaluating liver health and function. A complete blood count (CBC) primarily assesses red and white blood cells and platelets, not directly related to jaundice. Platelet count specifically measures platelets in the blood and is unrelated to the yellow skin observed in this patient. Blood urea nitrogen and creatinine tests focus on kidney function, not typically associated with yellow skin, making them less relevant in this context.

5. A client with long-standing heart failure being treated for cancer has received a dose of ondansetron for nausea. What action by the nurse is most important?

• A. Assess the client for a headache or dizziness.
• B. Request a prescription for cardiac monitoring.
• C. Instruct the client to change positions slowly.
• D. Weigh the client daily before eating.

Correct answer: B

Rationale: Ondansetron can prolong the QT interval, making cardiac monitoring essential in this scenario.

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