Nursing Elites

1. Diagnostic testing has resulted in a diagnosis of acute myeloid leukemia (AML) in an adult patient who is otherwise healthy. The patient and the care team have collaborated and the patient will soon begin induction therapy. The nurse should prepare the patient for which of the following?

• A. Daily treatment with targeted therapy medications
• B. Radiation therapy on a daily basis
• C. Hematopoietic stem cell transplantation
• D. An aggressive course of chemotherapy

Correct answer: D

Rationale: Attempts are made to achieve remission of AML by the aggressive administration of chemotherapy.

2. A client is receiving rituximab and asks how it works. What response by the nurse is best?

• A. It causes rapid lysis of the cancer cell membranes.
• B. It destroys the enzymes needed to create cancer cells.
• C. It prevents the start of cell division in the cancer cells.
• D. It sensitizes certain cancer cells to chemotherapy.

Correct answer: C

Rationale: Rituximab is a monoclonal antibody that targets CD20, a protein found on the surface of certain B-cells, including some cancerous B-cells, such as in non-Hodgkin's lymphoma and chronic lymphocytic leukemia (CLL). Rituximab works by binding to the CD20 protein, which leads to the destruction of the cancerous B-cells through various mechanisms, including preventing the initiation of cell division. By blocking the division process, rituximab helps slow the growth and proliferation of cancer cells, allowing the immune system and additional treatments to clear them more effectively.

3. After receiving a diagnosis of acute lymphocytic leukemia, a patient is visibly distraught, stating, I have no idea where to go from here. How should the nurse prepare to meet this patients psychosocial needs?

• A. Assess the patients previous experience with the health care system.
• B. Reassure the patient that treatment will be challenging but successful.
• C. Assess the patients specific needs for education and support.
• D. Identify the patients plan of medical care.

Correct answer: C

Rationale: In order to meets the patients needs, the nurse must first identify the specific nature of these needs.

4. A nurse is caring for a patient who has been diagnosed with leukemia. The nurse's most recent assessment reveals the presence of ecchymoses on the patient's sacral area and petechiae on her forearms. In addition to informing the patient's primary care provider, what action should the nurse take?

• A. Initiate measures to prevent venous thromboembolism (VTE).
• B. Check the patient's most recent platelet level.
• C. Place the patient on protective isolation.
• D. Ambulate the patient to promote circulatory function.

Correct answer: B

Rationale: The patient's signs of ecchymoses and petechiae are suggestive of thrombocytopenia, which is a common complication of leukemia. Thrombocytopenia is a condition characterized by a low platelet count, leading to abnormal bleeding. Checking the patient's most recent platelet level is crucial to assess the severity of thrombocytopenia and guide further interventions. Initiating measures to prevent venous thromboembolism (VTE) (Choice A) is not directly related to the patient's current signs. Placing the patient on protective isolation (Choice C) is not necessary for ecchymoses and petechiae. Ambulating the patient (Choice D) is not appropriate without addressing the underlying cause of abnormal bleeding.

5. The nurse on a bone marrow transplant unit is caring for a patient with cancer who is preparing for HSCT. What is a priority nursing diagnosis for this patient?

• A. Fatigue related to altered metabolic processes
• B. Altered nutrition: less than body requirements related to anorexia
• C. Risk for infection related to altered immunologic response
• D. Body image disturbance related to weight loss and anorexia

Correct answer: C

Rationale: Patients preparing for hematopoietic stem cell transplantation (HSCT) undergo intensive chemotherapy and/or radiation, which significantly suppresses their immune system. This immunosuppression leads to a heightened risk for infection, making it the most critical nursing diagnosis for these patients. As the body’s ability to fight off pathogens is compromised, close monitoring and interventions aimed at preventing infections are essential for their safety and recovery.

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