Nursing Elites

1. A public health nurse has formed an interdisciplinary team that is developing an educational program entitled Cancer: The Risks and What You Can Do About Them. Participants will receive information, but the major focus will be screening for relevant cancers. This program is an example of what type of health promotion activity?

• A. Disease prophylaxis
• B. Risk reduction
• C. Secondary prevention
• D. Tertiary prevention

Correct answer: C

Rationale: Secondary prevention involves screening and early detection activities that seek to identify early-stage cancer in individuals who lack symptoms.

2. A client is diagnosed as having a positive reaction to the Mantoux test. Which of the following is the most appropriate nursing action?

• A. Isolate the client in a private room.
• B. Administer isoniazid (INH) as prescribed.
• C. Schedule the client for a chest x-ray.
• D. Begin a 9-month course of medication therapy.

Correct answer: C

Rationale: The correct answer is to schedule the client for a chest x-ray. A positive Mantoux test indicates exposure to TB, but it does not confirm active disease. A chest x-ray is necessary to assess the presence of active TB disease. Isolating the client in a private room (Choice A) is not necessary based solely on a positive Mantoux test result. Administering isoniazid (INH) (Choice B) or beginning a 9-month course of medication therapy (Choice D) is premature without confirming active TB through a chest x-ray.

3. The nurse is monitoring a client for signs and symptoms related to superior vena cava syndrome. Which is an early sign of this oncological emergency?

• A. Cyanosis
• B. Arm edema
• C. Periorbital edema
• D. Mental status changes

Correct answer: C

Rationale: Superior vena cava syndrome (SVCS) occurs when the superior vena cava, the large vein that carries blood from the upper body to the heart, becomes compressed or obstructed, often by a tumor or enlarged lymph nodes, typically in cancers like lung cancer or lymphoma. The obstruction leads to increased venous pressure and reduced blood flow, resulting in swelling and edema in areas drained by the superior vena cava. Periorbital edema (swelling around the eyes) is one of the earliest signs of SVCS. This occurs because the impaired venous return causes fluid to accumulate in the soft tissues of the face, especially around the eyes. As the condition progresses, facial swelling can worsen, and other symptoms develop.

4. 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.

5. A nurse is caring for a patient with myelodysplastic syndrome (MDS) who is receiving erythropoietin therapy. What should the nurse monitor to evaluate the effectiveness of this treatment?

• A. Platelet count
• B. Hemoglobin level
• C. White blood cell count
• D. Oxygen saturation

Correct answer: B

Rationale: Erythropoietin therapy is used to stimulate the production of red blood cells in patients with myelodysplastic syndrome (MDS), a disorder characterized by ineffective blood cell production, including red blood cells. The primary goal of erythropoietin therapy is to increase red blood cell count, improving the patient's oxygen-carrying capacity and reducing symptoms of anemia, such as fatigue and weakness. Monitoring hemoglobin levels is the best way to evaluate the effectiveness of this therapy because it directly reflects the patient's red blood cell count and the success of erythropoiesis (red blood cell production).

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