Nursing Elites

1. The nurse is caring for a patient with an advanced stage of breast cancer and the patient has recently learned that her cancer has metastasized. The nurse enters the room and finds the patient struggling to breathe and the nurse’s rapid assessment reveals that the patient’s jugular veins are distended. The nurse should suspect the development of what oncologic emergency?

• A. Increased intracranial pressure
• B. Superior vena cava syndrome (SVCS)
• C. Spinal cord compression
• D. Metastatic tumor of the neck

Correct answer: B

Rationale: Superior vena cava syndrome (SVCS) occurs when the superior vena cava, the large vein responsible for returning blood from the upper body to the heart, becomes obstructed or compressed, often due to a tumor, such as metastasized breast cancer. SVCS results in impaired venous drainage, leading to symptoms like distended jugular veins, facial swelling, difficulty breathing (dyspnea), and upper body edema. It is a medical emergency that requires prompt intervention to restore blood flow and alleviate symptoms.

2. The nurse is caring for a patient who is to begin receiving external radiation for a malignant tumor of the neck. While providing patient education, what potential adverse effects should the nurse discuss with the patient?

• A. Impaired nutritional status
• B. Cognitive changes
• C. Diarrhea
• D. Alopecia

Correct answer: A

Rationale: Corrected Rationale: Impaired nutritional status is a potential adverse effect of radiotherapy to the head and neck due to alterations in oral mucosa and taste. While cognitive changes, diarrhea, and alopecia can be side effects of other treatments or conditions, they are not typically associated with external radiation for a malignant tumor of the neck. Therefore, the nurse should primarily focus on discussing the risk of impaired nutritional status with the patient.

3. A client with cancer is receiving palliative care. Which statement by the client indicates an understanding of palliative care?

• A. Palliative care focuses on managing symptoms and improving quality of life.
• B. Palliative care is only provided when curative treatment is no longer an option.
• C. Palliative care includes interventions to prolong life at all costs.
• D. Palliative care provides support for both the client and their family.

Correct answer: A

Rationale: The correct answer is A. Palliative care focuses on managing symptoms and improving the quality of life for clients with serious illnesses like cancer. Choice B is incorrect as palliative care can be provided alongside curative treatments. Choice C is incorrect because palliative care does not aim to prolong life at all costs; it focuses on improving the quality of life. Choice D is partially correct but does not fully capture the essence of palliative care, which includes symptom management and holistic support for the client and their family.

4. Which of the following is considered correct in dealing with a patient who has gastric cancer?

• A. After total gastrectomy, patient will have to increase fluids during meals
• B. After total gastrectomy, patient will need lots of fiber in the diet
• C. After total gastrectomy, patient will have to walk about after meals
• D. After total gastrectomy, patient will have to lie flat on bed after meals

Correct answer: D

Rationale: After a total gastrectomy, where the entire stomach is removed, patients can experience dumping syndrome due to the rapid passage of food into the small intestine. This condition can lead to symptoms such as nausea, vomiting, diarrhea, and abdominal cramps. Lying flat after meals can help slow down the movement of food into the intestines, reducing the risk of dumping syndrome. It's important for patients to follow dietary recommendations and positioning strategies to manage symptoms effectively.

5. When preparing for the patient's subsequent care after completing the full course of treatment for acute lymphocytic leukemia without a significant response, what action should the nurse take?

• A. Arrange a meeting between the patient's family and the hospital chaplain.
• B. Assess the factors underlying the patient's failure to adhere to the treatment regimen.
• C. Encourage the patient to vigorously pursue complementary and alternative medicine (CAM).
• D. Identify the patient's specific wishes around end-of-life care.

Correct answer: D

Rationale: In cases where a patient does not respond appreciably to therapy, it is crucial to identify and respect the patient's choices regarding treatment, including preferences for end-of-life care. Option A is incorrect because it focuses on spiritual support rather than the patient's care preferences. Option B is incorrect as it assumes non-adherence to treatment without evidence. Option C is incorrect as it suggests an alternative treatment approach without considering the patient's wishes for end-of-life care.

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