Nursing Elites

1. The nurse is reviewing the laboratory results of a client diagnosed with multiple myeloma. Which would the nurse expect to note specifically in this disorder?

• A. Increased calcium level
• B. Increased white blood cells
• C. Decreased blood urea nitrogen level
• D. Decreased number of plasma cells in the bone marrow

Correct answer: A

Rationale: In multiple myeloma, the nurse would expect to note an increased calcium level in the laboratory results. This elevation is due to bone destruction caused by the disease, releasing calcium into the bloodstream. Increased white blood cells (Choice B) are not typically associated with multiple myeloma. Additionally, a decreased blood urea nitrogen level (Choice C) is not a common finding in this disorder. Multiple myeloma is characterized by the proliferation of abnormal plasma cells in the bone marrow, leading to an increased number of plasma cells, not a decreased number (Choice D). Therefore, the correct answer is an increased calcium level.

2. A nurse in the oncology clinic is providing preoperative education to a client just diagnosed with cancer. The client has been scheduled for surgery in 3 days. What action by the nurse is best?

• A. Call the client at home the next day to review teaching.
• B. Give the client information about a cancer support group.
• C. Provide all the preoperative instructions in writing.
• D. Reassure the client that surgery will be over soon.

Correct answer: A

Rationale: Clients are often overwhelmed by a sudden cancer diagnosis; therefore, it is best for the nurse to call the client at home the next day to review teaching. This approach allows the client time to process the information before the surgery. Choice B may be beneficial but is not the priority at this time. Providing written instructions (Choice C) is helpful but does not offer the personalized interaction needed. Reassuring the client (Choice D) is important but does not address the educational aspect of preoperative preparation.

3. When planning care for a 77-year-old male admitted with suspected acute myeloid leukemia (AML), what epidemiologic fact should the nurse be aware of?

• A. Early diagnosis is associated with good outcomes.
• B. Five-year survival for older adults is approximately 50%.
• C. Five-year survival for patients over 75 years old is less than 2%.
• D. Survival rates are wholly dependent on the patient's pre-illness level of health.

Correct answer: C

Rationale: In the context of AML, the 5-year survival rate significantly decreases with age. The 5-year survival rate for patients over 75 years old is less than 2% compared to 43% for those 50 years or younger, and 19% for those between 50 and 64 years. Choice A is incorrect as early diagnosis does not necessarily guarantee good outcomes in AML. Choice B is inaccurate as the 5-year survival rate is not approximately 50% for older adults with AML. Choice D is incorrect as survival rates for AML patients are influenced by various factors beyond just the pre-illness level of health.

4. The patient is anxious about subjection to radiation therapy. Which of the following statements of the student nurse requires additional teaching?

• A. Teletherapy is radiation from an external source.
• B. Brachytherapy can be administered via oral or IV.
• C. Brachytherapy is a radiation from inside the patient's body.
• D. Chemotherapy is effective in killing all cancer cells.

Correct answer: D

Rationale: The correct answer is D because the statement 'Chemotherapy is effective in killing all cancer cells' is incorrect. Chemotherapy does not kill all cancer cells and is not the same as radiation therapy. Chemotherapy targets rapidly dividing cells, including cancer cells, but it may not kill every single cancer cell. It is important for the student nurse to understand and communicate this distinction to the patient. Choices A, B, and C provide accurate information about teletherapy, brachytherapy, and chemotherapy, respectively, and do not require additional teaching.

5. 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.

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