Nokea
A client with a history of prostate cancer is in the clinic and reports new onset of severe low back pain. What action by the nurse is most important?
- A. Assess the client's gait and balance.
- B. Ask the client about any changes in urinary symptoms.
- C. Document the report thoroughly.
- D. Inquire about the client's recent activities.
Correct Answer: A
Rationale: The correct action by the nurse is to assess the client's gait and balance. Severe low back pain in a client with a history of prostate cancer may indicate spinal cord compression, a serious complication. Assessing gait and balance can help determine if there is any spinal cord involvement, which requires immediate medical attention. Asking about changes in urinary symptoms (choice B) is important to assess for possible urinary obstruction, but assessing gait and balance takes precedence due to the risk of spinal cord compression. Documenting the report thoroughly (choice C) is essential but not the most immediate action needed. Inquiring about recent activities (choice D) is not as critical as assessing for spinal cord involvement.
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The nurse is caring for a client who is postoperative following a pelvic exenteration, and the health care provider changes the client's diet from NPO status to clear liquids. The nurse should check which priority item before administering the diet?
- A. Bowel sounds
- B. Ability to ambulate
- C. Incision appearance
- D. Urine specific gravity
Correct Answer: A
Rationale: The correct answer is A: Bowel sounds. Checking for bowel sounds is crucial before administering any diet to ensure the gastrointestinal tract is functioning properly following surgery. This assessment helps prevent complications such as paralytic ileus. Choices B, C, and D are not the priority in this situation. While the ability to ambulate, incision appearance, and urine specific gravity are important assessments, ensuring bowel function takes precedence in this postoperative scenario.
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.
Following an extensive diagnostic workup, an older adult patient has been diagnosed with a secondary myelodysplastic syndrome (MDS). What assessment question most directly addresses the potential etiology of this patient's health problem?
- A. Were you ever exposed to toxic chemicals in any of the jobs that you held?
- B. When you were younger, did you tend to have recurrent infections of any kind?
- C. Have your parents or siblings had any disease like this?
- D. Would you say that you've had a lot of sun exposure in your lifetime?
Correct Answer: A
Rationale: The correct answer is A. Secondary MDS can occur at any age and results from prior toxic exposure to chemicals, including chemotherapeutic medications. Asking about exposure to toxic chemicals in previous jobs directly addresses the potential etiology of this patient's health problem. Choices B, C, and D are not as directly related to the etiology of secondary MDS. Recurrent infections (Choice B) are not a known cause of MDS. Family history (Choice C) is more pertinent to primary MDS, which has a genetic component, while sun exposure (Choice D) is not associated with the etiology of MDS.
A nurse is caring for a patient diagnosed with chronic myeloid leukemia (CML) who is receiving the drug imatinib (Gleevec). What should the nurse monitor in this patient to assess for side effects of this therapy?
- A. Cardiac function
- B. Renal function
- C. Liver function
- D. Pulmonary function
Correct Answer: A
Rationale: The correct answer is A: Cardiac function. Imatinib can cause fluid retention and heart failure, so cardiac function should be closely monitored. Renal function (choice B) is not typically affected by imatinib. Liver function (choice C) is not the primary concern with this medication. Pulmonary function (choice D) is not directly impacted by imatinib therapy.
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.