Nursing Elites

1. A patient with acute myeloid leukemia (AML) is receiving induction therapy. What is the priority nursing intervention during this phase of treatment?

• A. Administering pain management
• B. Monitoring for signs of infection
• C. Providing emotional support
• D. Monitoring fluid balance

Correct answer: B

Rationale: Induction therapy for acute myeloid leukemia (AML) involves intensive chemotherapy aimed at achieving remission by eliminating a large number of cancerous cells. However, this aggressive treatment also severely reduces the production of healthy blood cells, including neutrophils, which leads to neutropenia (a dangerously low number of neutrophils). This makes the patient highly susceptible to infections, which can be life-threatening. Monitoring for signs of infection is critical during this phase, as infections may occur quickly and progress rapidly due to the compromised immune system. Early detection and prompt treatment of infections are vital to improving patient outcomes during induction therapy.

2. 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.

3. Following an extensive diagnostic workup, an older adult patient has been diagnosed with a secondary myelodysplastic syndrome (MDS). What assessment question most directly addresses the potential etiology of this patient's health problem?

• A. Were you ever exposed to toxic chemicals in any of the jobs that you held?
• B. When you were younger, did you tend to have recurrent infections of any kind?
• C. Have your parents or siblings had any disease like this?
• D. Would you say that you've had a lot of sun exposure in your lifetime?

Correct answer: A

Rationale: The correct answer is A. Secondary MDS can occur at any age and results from prior toxic exposure to chemicals, including chemotherapeutic medications. Asking about exposure to toxic chemicals in previous jobs directly addresses the potential etiology of this patient's health problem. Choices B, C, and D are not as directly related to the etiology of secondary MDS. Recurrent infections (Choice B) are not a known cause of MDS. Family history (Choice C) is more pertinent to primary MDS, which has a genetic component, while sun exposure (Choice D) is not associated with the etiology of MDS.

4. Nurse Kent is teaching a male client to perform monthly testicular self-examinations. Which of the following points would be appropriate to make?

• A. Testicular cancer is a highly curable type of cancer
• B. Testicular cancer is very difficult to diagnose.
• C. Testicular cancer is the number one cause of cancer deaths in males.
• D. Testicular cancer is more common in older men.

Correct answer: A

Rationale: Testicular cancer is indeed highly treatable and curable, particularly when detected early through regular self-examinations. The survival rates for testicular cancer are very high, with many cases being treatable even if the cancer has spread, thanks to effective treatment options such as surgery, chemotherapy, and radiation therapy. Educating clients on the importance of early detection through monthly testicular self-examinations can empower them to recognize any changes early, increasing the likelihood of successful treatment.

5. The nurse is caring for a client following a mastectomy. Which nursing intervention would assist in preventing lymphedema of the affected arm?

• A. Placing cool compresses on the affected arm
• B. Elevating the affected arm on a pillow above heart level
• C. Avoiding arm exercises in the immediate postoperative period
• D. Maintaining an intravenous site below the antecubital area on the affected side

Correct answer: B

Rationale: After a mastectomy, particularly when lymph nodes are removed, there is an increased risk of lymphedema in the affected arm due to impaired lymphatic drainage. Elevating the affected arm above heart level helps promote lymphatic drainage and reduces the risk of swelling. This intervention facilitates the return of lymph fluid and helps prevent fluid accumulation in the arm.

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