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 62-year-old woman diagnosed with breast cancer is scheduled for a partial mastectomy. The oncology nurse explained that the surgeon will want to take tissue samples to ensure the disease has not spread to adjacent axillary lymph nodes. The patient has asked if she will have her lymph nodes dissected, like her mother did several years ago. What alternative to lymph node dissection will this patient most likely undergo?

• A. Lymphadenectomy
• B. Needle biopsy
• C. Open biopsy
• D. Sentinel node biopsy

Correct answer: D

Rationale: Sentinel lymph node biopsy is a minimally invasive alternative to more extensive lymph node dissection. This procedure involves identifying and removing the first lymph node(s) to which a tumor drains, known as the sentinel node(s), to determine if cancer has spread beyond the primary site. Choices A, B, and C are incorrect because lymphadenectomy refers to the surgical removal of lymph nodes, needle biopsy involves sampling tissue with a needle for analysis, and open biopsy refers to the surgical removal of a sample of tissue for examination, none of which specifically serve as an alternative to lymph node dissection in this context.

3. A 54-year-old has a diagnosis of breast cancer and is tearfully discussing her diagnosis with the nurse. The patient states, 'They tell me my cancer is malignant, while my coworker's breast tumor was benign. I just don't understand at all.' When preparing a response to this patient, the nurse should be cognizant of what characteristic that distinguishes malignant cells from benign cells of the same tissue type?

• A. Slow rate of mitosis of cancer cells
• B. Different proteins in the cell membrane
• C. Differing size of the cells
• D. Different molecular structure in the cells

Correct answer: B

Rationale: The correct answer is B. Malignant cells have different proteins in their membranes, such as tumor-specific antigens, which distinguish them from benign cells. Choice A is incorrect as cancer cells typically have a rapid and uncontrolled rate of mitosis. Choice C is incorrect as the size of cells alone does not distinguish between malignant and benign cells. Choice D is incorrect as the molecular structure is not the primary characteristic that distinguishes between malignant and benign cells.

4. A nurse who works in an oncology clinic is assessing a patient who has arrived for a 2-month follow-up appointment following chemotherapy. The nurse notes that the patient's skin appears yellow. Which blood tests should be done to further explore this clinical sign?

• A. Liver function tests (LFTs)
• B. Complete blood count (CBC)
• C. Platelet count
• D. Blood urea nitrogen and creatinine

Correct answer: A

Rationale: Corrected Detailed Rationale: Yellow skin is a sign of jaundice, which is often associated with liver disease. Liver function tests (LFTs) help in evaluating liver health and function. A complete blood count (CBC) primarily assesses red and white blood cells and platelets, not directly related to jaundice. Platelet count specifically measures platelets in the blood and is unrelated to the yellow skin observed in this patient. Blood urea nitrogen and creatinine tests focus on kidney function, not typically associated with yellow skin, making them less relevant in this context.

5. A client is diagnosed as having a positive reaction to the Mantoux test. Which of the following is the most appropriate nursing action?

• A. Isolate the client in a private room.
• B. Administer isoniazid (INH) as prescribed.
• C. Schedule the client for a chest x-ray.
• D. Begin a 9-month course of medication therapy.

Correct answer: C

Rationale: The correct answer is to schedule the client for a chest x-ray. A positive Mantoux test indicates exposure to TB, but it does not confirm active disease. A chest x-ray is necessary to assess the presence of active TB disease. Isolating the client in a private room (Choice A) is not necessary based solely on a positive Mantoux test result. Administering isoniazid (INH) (Choice B) or beginning a 9-month course of medication therapy (Choice D) is premature without confirming active TB through a chest x-ray.

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