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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 patients 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 youve had a lot of sun exposure in your lifetime?
Correct Answer: A
Rationale: Secondary MDS can occur at any age and results from prior toxic exposure to chemicals, including chemotherapeutic medications. Family history, sun exposure, and previous infections are unrelated to the pathophysiology of secondary MDS.
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A nurse is planning the care of a patient who has been diagnosed with essential thrombocythemia (ET). What nursing diagnosis should the nurse prioritize when choosing interventions?
- A. Risk for Ineffective Tissue Perfusion
- B. Risk for Imbalanced Fluid Volume
- C. Risk for Ineffective Breathing Pattern
- D. Risk for Ineffective Thermoregulation
Correct Answer: A
Rationale: Patients with ET are at risk for hypercoagulation and consequent ineffective tissue perfusion. Fluid volume, breathing, and thermoregulation are not normally affected.
An oncology nurse is caring for a patient with multiple myeloma who is experiencing bone destruction. When reviewing the patients most recent blood tests, the nurse should anticipate what imbalance?
- A. Hypercalcemia
- B. Hyperproteinemia
- C. Elevated serum viscosity
- D. Elevated RBC count
Correct Answer: A
Rationale: Hypercalcemia may result when bone destruction occurs due to the disease process. Elevated serum viscosity occurs because plasma cells excrete excess immunoglobulin. RBC count will be decreased. Hyperproteinemia would not be present.
After receiving a diagnosis of acute lymphocytic leukemia, a patient is visibly distraught, stating, I have no idea where to go from here. How should the nurse prepare to meet this patients psychosocial needs?
- A. Assess the patients previous experience with the health care system.
- B. Reassure the patient that treatment will be challenging but successful.
- C. Assess the patients specific needs for education and support.
- D. Identify the patients plan of medical care.
Correct Answer: C
Rationale: In order to meet the patients needs, the nurse must first identify the specific nature of these needs. According to the nursing process, assessment must precede interventions. The plan of medical care is important, but not central to the provision of support. The patients previous health care is not a primary consideration, and the nurse cannot assure the patient of successful treatment.
A patient with non-Hodgkins lymphoma is receiving information from the oncology nurse. The patient asks the nurse why she should stop drinking and smoking and stay out of the sun. What would be the nurses best response?
- A. Everyone should do these things because theyre health promotion activities that apply to everyone.
- B. You dont want to develop a second cancer, do you?
- C. You need to do this just to be on the safe side.
- D. Its important to reduce other factors that increase the risk of second cancers.
Correct Answer: D
Rationale: The nurse should encourage patients to reduce other factors that increase the risk of developing second cancers, such as use of tobacco and alcohol and exposure to environmental carcinogens and excessive sunlight. The other options do not answer the patients question, and also make light of the patients question.
A patient who is undergoing consolidation therapy for the treatment of leukemia has been experiencing debilitating fatigue. How can the nurse best meet this patients needs for physical activity?
- A. Teach the patient about the risks of immobility and the benefits of exercise.
- B. Assist the patient to a chair during awake times, as tolerated.
- C. Collaborate with the physical therapist to arrange for stair exercises.
- D. Teach the patient to perform deep breathing and coughing exercises.
Correct Answer: B
Rationale: Sitting in a chair is preferable to bed rest, even if a patient is experiencing severe fatigue. A patient who has debilitating fatigue would not likely be able to perform stair exercises. Teaching about mobility may be necessary, but education must be followed by interventions that actually involve mobility. Deep breathing and coughing reduce the risk of respiratory complications but are not substitutes for physical mobility in preventing deconditioning.