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. Which of the following is a correct statement by the nurse to a patient under radiation therapy?

• A. Brachytherapy can be performed by a pregnant nurse.
• B. Teletherapy makes the patient radioactive.
• C. Brachytherapy is an internal radiation therapy.
• D. Teletherapy requires proper disposal of feces since it can be a source of radiation.

Correct answer: C

Rationale: The correct answer is C: 'Brachytherapy is an internal radiation therapy.' Brachytherapy involves the placement of radioactive sources inside or next to the area requiring treatment. This differs from teletherapy, which is external radiation therapy. Choice A is incorrect as pregnant individuals should avoid exposure to radiation. Choice B is incorrect because teletherapy does not make the patient radioactive; the radiation source is external. Choice D is incorrect as feces is not a significant source of radiation during teletherapy.

3. A healthcare professional is assessing a female client who is taking hormone therapy for breast cancer. What assessment finding requires the healthcare professional to notify the primary health care provider immediately?

• A. Irregular menses.
• B. Edema in the lower extremities.
• C. Ongoing breast tenderness.
• D. Red, warm, swollen calf.

Correct answer: D

Rationale: The correct answer is D. A red, warm, swollen calf may indicate a deep vein thrombosis, which is a medical emergency. This finding requires immediate notification of the primary health care provider to prevent potential complications such as pulmonary embolism. Choices A, B, and C are not indicative of life-threatening conditions and should be monitored but do not require immediate notification like a suspected deep vein thrombosis.

4. The nurse is instructing a client on ways to reduce the risk of lymphedema after a mastectomy. Which of the following should be emphasized?

• A. Elevate the affected arm
• B. Avoid lifting heavy objects
• C. Use compression garments as prescribed
• D. Avoid wearing tight clothing

Correct answer: D

Rationale: After a mastectomy, particularly when lymph nodes are removed, patients are at increased risk for developing lymphedema, which is a buildup of lymph fluid that can cause swelling in the affected arm. Wearing tight clothing can constrict lymphatic flow and increase the risk of developing lymphedema by impeding normal lymphatic drainage. Therefore, it is crucial to advise patients to avoid tight-fitting clothing, especially around the chest and arm areas.

5. A client receiving chemotherapy is experiencing severe nausea and vomiting. Which intervention should the nurse implement first?

• A. Administer antiemetics 30 minutes before chemotherapy.
• B. Offer small, frequent meals that are bland and easy to digest.
• C. Encourage the client to rest after meals to reduce nausea.
• D. Instruct the client to use relaxation techniques.

Correct answer: A

Rationale: The correct answer is A: Administer antiemetics 30 minutes before chemotherapy. Administering antiemetics before chemotherapy is crucial to prevent nausea rather than treating it after it occurs. This proactive approach helps in minimizing the side effects. Choice B, offering small, frequent meals, can be beneficial but is not the first intervention for severe nausea and vomiting. Choice C, encouraging rest after meals, may help but is not the priority when the client is experiencing severe symptoms. Choice D, instructing the client to use relaxation techniques, is not the first-line intervention for severe nausea and vomiting in a client receiving chemotherapy.

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