Nursing Elites

1. During the admission assessment of a client with advanced ovarian cancer, the nurse recognizes which symptom as typical of the disease?

• A. Diarrhea
• B. Hypermenorrhea
• C. Abnormal bleeding
• D. Abdominal distention

Correct answer: D

Rationale: Abdominal distention is a common symptom in advanced ovarian cancer due to several factors, including the accumulation of ascites (fluid in the abdominal cavity) and the presence of tumors that can increase abdominal girth. As the disease progresses, the pressure from growing masses or fluid buildup can lead to noticeable swelling and discomfort in the abdomen. This symptom often prompts further evaluation and can significantly impact the patient’s quality of life.

2. 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.

3. A patient with multiple myeloma is receiving chemotherapy and is at risk for bone fractures. What intervention should the nurse prioritize to reduce this risk?

• A. Encouraging bed rest
• B. Promoting bed rest to avoid injury
• C. Encouraging weight-bearing exercises
• D. Ensuring adequate hydration

Correct answer: B

Rationale: The correct answer is B: 'Promoting bed rest to avoid injury.' In patients with multiple myeloma undergoing chemotherapy, encouraging bed rest can lead to muscle weakness and bone loss, increasing the risk of fractures. Promoting bed rest to avoid injury means advising the patient on safe movement and activities to prevent fractures. Encouraging weight-bearing exercises (choice C) would be more beneficial than bed rest as it helps in maintaining bone density and strength. Ensuring adequate hydration (choice D) is essential for overall health but does not directly address the risk of bone fractures associated with multiple myeloma and chemotherapy. Choice A, 'Encouraging bed rest,' is incorrect as it may worsen the risk of fractures rather than reduce it.

4. 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.

5. After undergoing mastectomy, a patient demonstrates understanding of the nurse's instructions by doing which of the following?

• A. Dangle arms at the bedside
• B. Lie down on the affected chest
• C. Drink plenty of fluids immediately after surgery
• D. Elevate the affected arm

Correct answer: D

Rationale: The correct answer is to elevate the affected arm. Elevating the affected arm helps prevent lymphedema after a mastectomy. Choices A, B, and C are incorrect. 'Dangling arms at the bedside' does not provide any benefit after a mastectomy. 'Lying down on the affected chest' can cause discomfort and possible complications. 'Drinking plenty of fluids immediately after surgery' is not related to preventing lymphedema post-mastectomy.

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