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. A patient with Hodgkin lymphoma is receiving chemotherapy. Which side effect is the nurse most concerned about?

• A. Nausea and vomiting
• B. Alopecia
• C. Fatigue
• D. Peripheral neuropathy

Correct answer: D

Rationale: The correct answer is D, Peripheral neuropathy. This can be a serious and dose-limiting side effect of chemotherapy for Hodgkin lymphoma. Peripheral neuropathy can cause tingling, numbness, and pain in the hands and feet due to nerve damage. While nausea and vomiting, alopecia, and fatigue are common side effects of chemotherapy, they are not typically as concerning or dose-limiting as peripheral neuropathy in the context of Hodgkin lymphoma treatment.

3. The school nurse is teaching a nutrition class in the local high school. One student states that he has heard that certain foods can increase the incidence of cancer. The nurse responds, Research has shown that certain foods indeed appear to increase the risk of cancer. Which of the following menu selections would be the best choice for potentially reducing the risks of cancer?

• A. Smoked salmon and green beans
• B. Pork chops and fried green tomatoes
• C. Baked apricot chicken and steamed broccoli
• D. Liver, onions, and steamed peas

Correct answer: C

Rationale: The correct choice is 'Baked apricot chicken and steamed broccoli' because fruits and vegetables have been shown to reduce the risk of cancer. Option A, smoked salmon and green beans, although a healthy choice, does not incorporate as many cancer-fighting foods as the correct answer. Option B, pork chops and fried green tomatoes, contains fried food which is associated with increased cancer risk. Option D, liver, onions, and steamed peas, includes organ meats which are not considered beneficial for reducing cancer risk.

4. The clinic nurse is caring for a patient whose grandmother and sister have both had breast cancer. She requested a screening test to determine her risk of developing breast cancer and it has come back positive. The patient asks you what she can do to help prevent breast cancer from occurring. What would be your best response?

• A. Research has shown that eating a healthy diet can provide all the protection you need against breast cancer.
• B. Research has shown that taking the drug tamoxifen can reduce your chance of breast cancer.
• C. Research has shown that exercising at least 30 minutes every day can reduce your chance of breast cancer.
• D. Research has shown that there is little you can do to reduce your risk of breast cancer if you have a genetic predisposition.

Correct answer: B

Rationale: Tamoxifen is a selective estrogen receptor modulator (SERM) that has been shown to significantly reduce the risk of developing breast cancer in women who are at high risk, particularly those with a family history of the disease or a positive genetic test for BRCA mutations. Large-scale studies have demonstrated that tamoxifen can reduce the incidence of breast cancer by up to 50% in high-risk women. It works by blocking estrogen receptors in breast tissue, which helps prevent the development of estrogen receptor-positive breast cancers.

5. A nurse is teaching a patient with chronic lymphocytic leukemia (CLL) about potential complications. Which complication should the nurse emphasize?

• A. Infection
• B. Hemorrhage
• C. Fatigue
• D. Splenomegaly

Correct answer: A

Rationale: The correct answer is A: Infection. Patients with chronic lymphocytic leukemia (CLL) are at a significant risk of infection due to their compromised immune system. Emphasizing the importance of infection prevention and prompt treatment is crucial in the care of these patients. Choice B, Hemorrhage, is less common in CLL compared to other types of leukemia. Choice C, Fatigue, is a common symptom but not a complication that poses immediate risks. Choice D, Splenomegaly, is a common finding in CLL but not the most critical complication to emphasize regarding patient education.

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