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 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).

3. 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.

4. A nurse is preparing to administer filgrastim to a client undergoing chemotherapy. What is the primary purpose of this medication?

• A. Increase white blood cell production.
• B. Reduce the risk of infection.
• C. Enhance red blood cell production.
• D. Control chemotherapy-induced nausea and vomiting.

Correct answer: A

Rationale: Filgrastim is primarily used to increase white blood cell production in clients undergoing chemotherapy.

5. 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.

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