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For a patient who is experiencing side effects of radiation therapy, which task would be the most appropriate to delegate to the nursing assistant?
- A. Assist the patient to identify patterns of fatigue
- B. Recommend participation in a walking program
- C. Report the amount and type of food consumed from the tray
- D. Check the skin for redness and irritation after the treatment
Correct Answer: C
Rationale: Radiation side effects like fatigue and anorexia benefit from team care. Reporting food consumed from the tray suits nursing assistants observing and relaying intake data supports nutrition monitoring without requiring clinical judgment. Identifying fatigue patterns demands analysis, a nurse's role to adjust care plans. Recommending exercise exceeds assistants' scope physicians or RNs initiate such advice. Checking skin for redness post-treatment needs assessment skills to detect burns or infection, RN territory. Food reporting leverages assistants' observational role, aiding nurses in tracking radiation's impact on appetite, ensuring basic needs are flagged efficiently in a collaborative approach.
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The nurse caring for oncology clients knows that which form of metastasis is the most common?
- A. Bloodborne
- B. Direct invasion
- C. Lymphatic spread
- D. Via bone marrow
Correct Answer: A
Rationale: Metastasis is the process by which cancer spreads from its original site to distant parts of the body, a critical concern in oncology nursing. Among the various mechanisms, bloodborne metastasis is the most common, as cancer cells often enter the bloodstream and travel to organs like the lungs, liver, or brain. This occurs because the circulatory system provides an efficient pathway for tumor cells to disseminate widely, especially in cancers like breast or lung cancer. Lymphatic spread is also frequent, particularly in carcinomas, where cells travel via lymph nodes, but it is less dominant than bloodborne spread across all cancer types. Direct invasion involves cancer growing into adjacent tissues, which is a local process rather than true metastasis. Bone marrow is not a medium for metastasis but a potential site where cancer can settle, such as in leukemia or multiple myeloma. Understanding that bloodborne metastasis predominates helps nurses prioritize monitoring for systemic symptoms and complications, such as organ dysfunction, in clients with advanced cancer.
In patients who are awake during craniotomy, appropriate statements include:
- A. For a temporal lesion, neurosurgeons are likely to require the sitting position.
- B. A tracheal tube is likely to be used.
- C. A urinary catheter is likely to be inserted.
- D. Intraoperative seizures are likely to occur during cortical mapping.
Correct Answer: C
Rationale: Awake craniotomy allows functional mapping and patient cooperation. The sitting position is rare due to air embolism risks and is not specific to temporal lesions; supine or lateral positions are standard. A tracheal tube is avoided to maintain airway control via less invasive means (e.g., nasal cannula), as patients must remain responsive. A urinary catheter is routine for longer procedures to manage fluid balance and patient comfort, given immobility and duration. Patient anxiety is common but manageable, not an absolute contraindication. Seizures can occur during cortical mapping due to electrical stimulation, but likely' overstates frequency; they're a risk, not a certainty. The urinary catheter's inclusion reflects practical perioperative care, ensuring monitoring and comfort without interrupting the procedure's focus on brain function preservation.
A 58-year-old man with a known history of heart failure from cardiomyopathy, with an ejection fraction of 30 percent returns for a 3-week follow-up visit after being started on frusemide 40 mg od for increasing symptoms of dyspnea. Since starting frusemide, his symptoms have returned to baseline and he has lost 3 kg. He is maintained on guideline-directed medical therapy for heart failure including sacubitril/valsartan 97 mg/103 mg BD, carvedilol 12.5 mg BD, Simvastatin 40 mg ON, and aspirin 81 mg OD. His physical examination reveals: blood pressure of 128/80 mmHg, regular heart rate of 78 bpm, respiratory rate of 18 breaths/min, and room air oxygen saturation of 96 percent with no saturation decrease with hallway ambulation. He has no peripheral edema. A clinic electrocardiogram reveals a left bundle branch block with a QRS duration of >150 msec. What would be the most appropriate next step in management?
- A. Refer him to an electrophysiologist
- B. Discontinue the sacubitril/valsartan 97 mg/103 mg BD
- C. Change his diuretic to spironolactone 25 mg OD
- D. Increase the frusemide to 40 mg BD
Correct Answer: A
Rationale: HFrEF at 30% EF with LBBB >150 msec stabilized on meds hints at dyssynchrony, ripe for cardiac resynchronization therapy, so an electrophysiologist's next. Ditching sacubitril/valsartan or swapping diuretics lacks cause; upping frusemide or re-echoing waits. Clinicians tap this referral, boosting chronic pump sync, a guideline nod.
In which of these do you see clue cells?
- A. trichomonas vaginalis
- B. bacterial vaginosis
- C. candida
- D. HSV 2
Correct Answer: B
Rationale: Clue cells BV's fishy flag, not trich's swim, candida's yeast, HSV's sores, or syphilis' chancre. Nurses scope this chronic hint.
Regarding infective endocarditis in an IVDU
- A. Usually presents with fever and respiratory symptoms
- B. Usually involves the mitral valve
- C. The commonest organism is staph epidermidis
- D. Negative blood cultures exclude the diagnosis
Correct Answer: A
Rationale: IVDU endocarditis fever, lung emboli from tricuspid, not mitral, Staph aureus, cultures miss some. Nurses hear this chronic right-side roar.