Nursing Elites

1. The nurse is monitoring a client for signs and symptoms related to superior vena cava syndrome. Which is an early sign of this oncological emergency?

• A. Cyanosis
• B. Arm edema
• C. Periorbital edema
• D. Mental status changes

Correct answer: C

Rationale: Superior vena cava syndrome (SVCS) occurs when the superior vena cava, the large vein that carries blood from the upper body to the heart, becomes compressed or obstructed, often by a tumor or enlarged lymph nodes, typically in cancers like lung cancer or lymphoma. The obstruction leads to increased venous pressure and reduced blood flow, resulting in swelling and edema in areas drained by the superior vena cava. Periorbital edema (swelling around the eyes) is one of the earliest signs of SVCS. This occurs because the impaired venous return causes fluid to accumulate in the soft tissues of the face, especially around the eyes. As the condition progresses, facial swelling can worsen, and other symptoms develop.

2. A client is diagnosed with multiple myeloma and the client asks the nurse about the diagnosis. The nurse bases the response on which description of this disorder?

• A. Altered red blood cell production
• B. Altered production of lymph nodes
• C. Malignant exacerbation in the number of leukocytes
• D. Malignant proliferation of plasma cells within the bone

Correct answer: D

Rationale: Multiple myeloma is a type of cancer that involves the malignant proliferation of plasma cells, which are a type of white blood cell that produces antibodies. In multiple myeloma, these abnormal plasma cells accumulate in the bone marrow, where they interfere with the production of normal blood cells and lead to the formation of tumors in the bones. This can cause bone pain, fractures, anemia, and impaired immune function. The excessive production of abnormal antibodies can also result in kidney damage and other systemic complications.

3. A nurse knows that all of the following are managements of breast cancer except:

• A. Administer chemotherapy as ordered
• B. Let the patient lie down with 1-2 pillows
• C. Give patient Tamoxifen as ordered
• D. Let the patient elevate affected arm post op

Correct answer: B

Rationale: In the management of breast cancer, particularly after procedures such as a mastectomy, it is important to position the patient in a way that promotes healing and comfort. However, lying down with 1-2 pillows is not a standard practice for postoperative care. Instead, patients are often advised to elevate the affected arm to reduce swelling and promote drainage, and they may benefit from sleeping in a more upright position if they are experiencing discomfort. The focus should be on facilitating recovery rather than simply lying down.

4. A patient has been found to have an indolent neoplasm. The nurse should recognize what implication of this condition?

• A. The patient faces a significant risk of malignancy.
• B. The patient has a myeloid form of leukemia.
• C. The patient has a lymphocytic form of leukemia.
• D. The patient has a major risk factor for hemophilia.

Correct answer: A

Rationale: The correct answer is A: 'The patient faces a significant risk of malignancy.' Indolent neoplasms are characterized by their slow growth and relatively low malignancy potential; however, they do have the capability to progress to malignancy over time. Choices B, C, and D are incorrect because they make assumptions about specific types of leukemia and hemophilia, which are not necessarily related to the presence of an indolent neoplasm.

5. A client is receiving rituximab. What assessment by the nurse takes priority?

• A. Blood pressure.
• B. Temperature.
• C. Oral mucous membranes.
• D. Pain.

Correct answer: A

Rationale: When a client is receiving rituximab, the nurse's priority assessment should be monitoring the blood pressure. Rituximab can lead to infusion-related reactions, such as hypotension. Therefore, assessing the client's blood pressure is crucial to detect and manage any potential adverse reactions promptly. While monitoring temperature, oral mucous membranes, and pain are essential aspects of care, they are not the priority when a client is receiving rituximab.

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