Nursing Elites

1. 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.

2. A client who has been receiving radiation therapy for bladder cancer tells the nurse that it feels as if she is voiding through the vagina. The nurse interprets that the client may be experiencing which condition?

• A. Rupture of the bladder
• B. The development of a vesicovaginal fistula
• C. Extreme stress caused by the diagnosis of cancer
• D. Altered perineal sensation as a side effect of radiation therapy

Correct answer: B

Rationale: The correct answer is B. A vesicovaginal fistula is an abnormal connection between the bladder and the vagina, leading to the passage of urine through the vagina. This condition can occur due to various reasons, including radiation therapy. Choice A, rupture of the bladder, is incorrect because a rupture would present with more severe symptoms and is not consistent with the client's description. Choice C, extreme stress, is incorrect as it does not explain the physical symptom of voiding through the vagina. Choice D, altered perineal sensation, is incorrect as it does not involve a direct connection between the bladder and the vagina.

3. The nurse is instructing the 35 year old client to perform a testicular self-examination. The nurse tells the client:

• A. To examine the testicles while lying down
• B. That the best time for the examination is after a shower
• C. To gently feel the testicle with one finger to feel for a growth
• D. That testicular self-examination should be done at least every 6 months

Correct answer: B

Rationale: The best time to perform a testicular self-examination (TSE) is after a warm shower or bath. The heat from the water relaxes the scrotal skin, making it easier to feel any abnormalities, lumps, or changes in the testicles. This relaxation allows for a more thorough and accurate examination.

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. The client is assessing a client who has a new ureterostomy. Which statement by the client indicates the need for more education about urinary stoma care?

• A. I change my pouch every week.
• B. I change the appliance in the morning.
• C. I empty the urinary collection bag when it is two-thirds full.
• D. When I'm in the shower, I direct the flow of water away from my stoma.

Correct answer: D

Rationale: The correct answer is D because directing water away from the stoma while showering is incorrect. The stoma can and should be cleaned with water. Choices A, B, and C demonstrate proper stoma care practices, such as changing the pouch regularly, changing the appliance in the morning, and emptying the collection bag when it is two-thirds full, which are all appropriate actions for caring for a urinary stoma.

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