Nursing Elites

1. You are caring for a patient who has just been told that her stage IV colon cancer has recurred and metastasized to the liver. The oncologist offers the patient the option of surgery to treat the progression of this disease. What type of surgery does the oncologist offer?

• A. Palliative
• B. Reconstructive
• C. Salvage
• D. Prophylactic

Correct answer: A

Rationale: The correct answer is A: Palliative. Palliative surgery is aimed at relieving symptoms and improving quality of life when a cure is not possible. In this scenario, where the cancer has recurred and metastasized, the goal of surgery would be to alleviate symptoms rather than to cure the disease. Choices B, C, and D are incorrect because reconstructive surgery aims to restore function or appearance, salvage surgery aims to remove or salvage tissue to prevent further complications, and prophylactic surgery aims to prevent the development of a condition rather than treat its progression.

2. An older adult patient is undergoing diagnostic testing for chronic lymphocytic leukemia (CLL). What assessment finding is certain to be present if the patient has CLL?

• A. Increased numbers of blast cells
• B. Increased lymphocyte levels
• C. Intractable bone pain
• D. Thrombocytopenia with no evidence of bleeding

Correct answer: B

Rationale: An increased lymphocyte count (lymphocytosis) is always present in patients with CLL.

3. A nursing student is caring for a patient with acute myeloid leukemia who is preparing to undergo induction therapy. In preparing a plan of care for this patient, the student should assign the highest priority to which nursing diagnosis?

• A. Activity Intolerance
• B. Risk for Infection
• C. Acute Confusion
• D. Risk for Spiritual Distress

Correct answer: B

Rationale: The correct answer is B: Risk for Infection. Induction therapy for acute myeloid leukemia suppresses the immune system, making the patient highly susceptible to infections due to neutropenia. Preventing infections is crucial in these patients to avoid complications. Activity Intolerance (Choice A) may be a concern, but infection prevention is of higher priority. Acute Confusion (Choice C) and Risk for Spiritual Distress (Choice D) are not the immediate priorities in this situation.

4. An emergency department nurse is triaging a 77-year-old man who presents with uncharacteristic fatigue as well as back and rib pain. The patient denies any recent injuries. The nurse should recognize the need for this patient to be assessed for what health problem?

• A. Hodgkin disease
• B. Non-Hodgkin lymphoma
• C. Multiple myeloma
• D. Acute thrombocythemia

Correct answer: C

Rationale: The correct answer is multiple myeloma (choice C). Back pain is a common presenting symptom in multiple myeloma, especially in older patients. This malignancy can lead to bone pain due to bone destruction and fractures. Hodgkin disease (choice A) and Non-Hodgkin lymphoma (choice B) typically present with symptoms like painless lymph node enlargement, fever, and weight loss. Acute thrombocythemia (choice D) is characterized by an increase in platelet count but is not typically associated with the symptoms described by the patient.

5. The clinic nurse is caring for a 42-year-old male oncology patient. He complains of extreme fatigue and weakness after his first week of radiation therapy. Which response by the nurse would best reassure this patient?

• A. These symptoms usually result from radiation therapy; however, we will continue to monitor your laboratory and x-ray studies.
• B. These symptoms are part of your disease and are an unfortunately inevitable part of living with cancer.
• C. Try not to be concerned about these symptoms. Every patient feels this way after having radiation therapy.
• D. Even though it is uncomfortable, this is a good sign. It means that only the cancer cells are dying.

Correct answer: A

Rationale: Fatigue and weakness are common side effects of radiation therapy, often due to the body’s response to radiation damage and the energy required to repair both cancerous and healthy cells affected by the treatment. Reassuring the patient that these symptoms are expected while also emphasizing ongoing monitoring (through lab and x-ray studies) provides both comfort and a sense of proactive care. It ensures the patient that their symptoms are being addressed in a safe and medically appropriate way.

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