Nursing Elites

1. The client is diagnosed with multiple myeloma. The doctor has ordered cyclophosphamide (Cytoxan). Which instruction should be given to the client?

• A. "Walk about a mile a day to prevent calcium loss."?
• B. "Increase the fiber in your diet."?
• C. "Report nausea to the doctor immediately."?
• D. "Drink at least eight large glasses of water a day."?

Correct answer: D

Rationale: Cyclophosphamide (Cytoxan) can cause hemorrhagic cystitis, a condition characterized by inflammation of the bladder wall leading to bleeding. To prevent this complication, the client should drink at least eight glasses of water a day. Walking to prevent calcium loss (choice A) and increasing fiber intake (choice B) are not directly related to the side effects of Cytoxan, making them unnecessary instructions in this case. While nausea is a common side effect of chemotherapy, the immediate reporting of nausea to the doctor (choice C) is important but not specifically related to the use of Cytoxan in this scenario.

2. When supporting a family who has just experienced a sudden and unexpected death, the nurse needs to know:

• A. that survivors have greater emotional turmoil and shock than when death is expected.
• B. that survivors have less emotional turmoil and shock than when death is expected.
• C. that survivors have the same emotional turmoil and shock as when death is expected.
• D. that survivors have little emotional turmoil and shock because they were not there.

Correct answer: A

Rationale: The correct answer is that survivors have greater emotional turmoil and shock than when death is expected. Sudden death produces more emotional turmoil and shock in survivors compared to gradual, expected death. Survivors of sudden death do not have the opportunity to engage in anticipatory grief. The unexpectedness of sudden death is the most disturbing and unbalancing factor, leading to heightened emotional turmoil and shock. Choice B is incorrect as survivors of sudden death experience more emotional turmoil and shock. Choice C is incorrect because sudden death brings about a different level of emotional turmoil and shock. Choice D is incorrect as survivors of sudden and unexpected death still go through significant emotional distress.

3. James returns home from school angry and upset because his teacher gave him a low grade on an assignment. After returning home from school, he kicks the dog. This coping mechanism is known as:

• A. denial
• B. suppression
• C. displacement
• D. fantasy

Correct answer: C

Rationale: The correct answer is 'displacement.' Displacement is a defense mechanism where emotions or impulses are transferred from their original source to a substitute target. In this scenario, James is displacing his anger from his teacher onto the dog. Choice A, 'denial,' involves refusing to acknowledge an unpleasant reality. Choice B, 'suppression,' is the conscious effort to push unwanted thoughts out of awareness. Choice D, 'fantasy,' refers to imagining scenarios that fulfill one's desires but are not based in reality.

4. The nurse is making assignments for the day. Which client should be assigned to the pregnant nurse?

• A. The client receiving linear accelerator radiation therapy for lung cancer
• B. The client with a radium implant for cervical cancer
• C. The client who has just been administered soluble brachytherapy for thyroid cancer
• D. The client who returned from placement of iridium seeds for prostate cancer

Correct answer: A

Rationale: The pregnant nurse should not be assigned to any client with radioactivity present. The client receiving linear accelerator therapy is the correct choice because the radiation stays in the department, and the client is not radioactive. Choices B, C, and D involve clients who are radioactive or pose a risk due to radioactivity. The client with a radium implant for cervical cancer (choice B) is radioactive, the client who has just been administered soluble brachytherapy for thyroid cancer (choice C) is radioactive for approximately 72 hours, and the client who returned from placement of iridium seeds for prostate cancer (choice D) is also radioactive, especially right after the procedure. These options are not suitable for assignment to the pregnant nurse.

5. The new mother asks why her baby has lost weight since he was born. The best explanation of the weight loss is:

• A. The baby is dehydrated due to polyuria.
• B. The baby is hypoglycemic due to lack of glucose.
• C. The baby is allergic to the formula the mother is giving him.
• D. The baby can lose up to 10% of weight due to meconium stool, loss of extracellular fluid, and initiation of breastfeeding.

Correct answer: D

Rationale: After birth, newborns can lose weight due to meconium stool, loss of extracellular fluid, and the initiation of breastfeeding. This weight loss is a normal and expected physiological process, and infants can lose up to 10% of their birth weight during this period. There is no indication of dehydration (polyuria), hypoglycemia (lack of glucose), or allergy to the formula as reasons for weight loss in newborns. Therefore, answers A, B, and C are incorrect. Answer D provides the most accurate explanation for the observed weight loss in the newborn.

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