Nursing Elites

1. The nurse has taught a client with cancer ways to prevent infection. What statement by the client indicates that more teaching is needed?

• A. I should take my temperature daily and when I don’t feel well.
• B. I will discard perishable liquids after sitting out for over an hour.
• C. I won’t let anyone share any of my personal toiletries.
• D. It’s alright for me to keep my pets and change the litter box.

Correct answer: D

Rationale: Clients with cancer, especially those undergoing chemotherapy or other immunosuppressive treatments, are at increased risk for infections due to a weakened immune system. Changing a litter box exposes the client to pathogens such as Toxoplasma gondii and other harmful bacteria or parasites found in cat feces, which could lead to serious infections. It is recommended that immunocompromised individuals avoid activities like changing litter boxes to reduce their risk of exposure to infectious agents. A family member or caregiver should handle this task to protect the client.

2. The clinical nurse educator is presenting health promotion education to a patient who will be treated for non-Hodgkin lymphoma on an outpatient basis. The nurse should recommend which of the following actions?

• A. Avoiding direct sun exposure in excess of 15 minutes daily
• B. Avoiding grapefruit juice and fresh grapefruit
• C. Avoiding highly crowded public places
• D. Using an electric shaver rather than a razor

Correct answer: C

Rationale: Patients with non-Hodgkin lymphoma (NHL) often experience a compromised immune system due to both the disease itself and the effects of treatments like chemotherapy and radiation, which cause myelosuppression (decreased production of blood cells, including white blood cells). This puts them at significant risk for infections. Avoiding crowded places is a crucial preventive measure, as it reduces the patient's exposure to pathogens that could lead to infections, which can be particularly severe due to their weakened immune system.

3. A 60-year-old patient with chronic myeloid leukemia will be treated in the home setting and the nurse is preparing appropriate health education. What topic should the nurse emphasize?

• A. The importance of adhering to the prescribed drug regimen
• B. The need to ensure that vaccinations are up to date
• C. The importance of daily physical activity
• D. The need to avoid shellfish and raw foods

Correct answer: A

Rationale: Chronic myeloid leukemia (CML) is typically treated with targeted therapies, such as tyrosine kinase inhibitors (TKIs), which can help control the disease and prolong survival. The effectiveness of these medications relies heavily on strict adherence to the prescribed drug regimen. Patients need to take their medication consistently and as directed to maintain therapeutic drug levels and effectively manage the disease. Non-adherence can lead to disease progression or resistance to treatment, which is why it is crucial for the nurse to emphasize this point during health education.

4. A patient with a myelodysplastic syndrome is being treated on the medical unit. What assessment finding should prompt the nurse to contact the patients primary care provider?

• A. The patient is experiencing a frontal lobe headache.
• B. The patient has an episode of urinary incontinence.
• C. The patient has an oral temperature of 37.5C (99.5F).
• D. The patients SpO2 is 91% on room air.

Correct answer: C

Rationale: Patients with myelodysplastic syndrome (MDS) have a dysfunctional bone marrow that leads to ineffective blood cell production, including white blood cells, which are crucial for fighting infections. As a result, they are at high risk for infections. Even a slight elevation in temperature, such as 37.5°C (99.5°F), could be an early sign of infection in an immunocompromised patient. Early detection and treatment of infections are critical in MDS patients, as infections can quickly become severe or life-threatening due to their compromised immune system.

5. 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).

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