Nokea
The hospice nurse has just admitted a new patient to the program. What principle guides hospice care?
- A. Care addresses the needs of the patient as well as the needs of the family
- B. Care is focused on the patient centrally and the family peripherally
- C. The focus of all aspects of care is solely on the patient
- D. The care team prioritizes the patient's physical needs and the family is responsible for the patient's emotional needs
Correct Answer: A
Rationale: Hospice wraps the patient and family in care physical, emotional, spiritual for both, not just one. It's not patient-only or peripheral family focus; it's a unit. Splitting physical and emotional duties misses the holistic vibe. Nurses in oncology's endgame lean on this, ensuring comfort and support ripple out, easing the load for all as death nears.
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In infective endocarditis
- A. oslers nodes are tender
- B. Janeway lesions are tender
- C. Right ventricular MI is more likely to be acute than subacute
- D. A+C
Correct Answer: A
Rationale: Endocarditis Osler's nodes hurt, Janeway's don't, right heart's acute in IVDU. Nurses feel this chronic pain clue.
The nurse is caring for a patient receiving intravesical bladder chemotherapy. The nurse should monitor for which adverse effect?
- A. Nausea
- B. Alopecia
- C. Hematuria
- D. Xerostomia
Correct Answer: C
Rationale: Intravesical chemo (e.g., BCG for bladder cancer) targets the bladder lining directly hematuria (blood in urine) is the biggie to watch, signaling irritation or tumor breakdown. It's local, not systemic, so nausea and alopecia whole-body effects from IV chemo don't fit. Xerostomia (dry mouth) might tag along with systemic agents hitting salivary glands, not this route. Nurses track hematuria here because it's the bladder's cry for help, a common, expected reaction to drugs bathing the mucosa. In oncology, knowing delivery matters intravesical skips the bloodstream, keeping side effects bladder-focused, critical for patient comfort and spotting complications early.
A patient on the oncology unit is receiving carmustine, a chemotherapy agent, and the nurse is aware that a significant side effect of this medication is thrombocytopenia. Which symptom should the nurse assess for in patients at risk for thrombocytopenia?
- A. Interrupted sleep pattern
- B. Hot flashes
- C. Epistaxis (nose bleed)
- D. Increased weight
Correct Answer: C
Rationale: Carmustine, a nitrosourea, slams bone marrow, dropping platelets and causing thrombocytopenia low counts mean bleeding risks soar. Epistaxis (nosebleeds) is a classic sign, as mucosal vessels lack clotting support, especially with counts below 50,000/µL. Sleep issues might tie to discomfort but aren't direct. Hot flashes link to hormonal therapies, not this. Weight gain's unrelated cancer often causes loss. Nurses zero in on bleeding like epistaxis, bruising, or petechiae checking daily for these red flags, vital in oncology to catch and manage this life-threatening chemo fallout early.
Mr Soh, a 40-year-old accountant on allopurinol 200 mg OM for the past eight months, reports two recent gout attacks in the last year. He has no other known past medical history. When you probe, he is adherent to allopurinol except for missing it perhaps once or twice a month. His BMI is 25 kg/m², BP 144/94 mmHg. His last uric acid was one month ago, which was 405 mmol/L. He is having a gout attack now. He tells you that his gout attacks are usually aborted with colchicine TDS for two days. Whilst on colchicine, he does not experience diarrhoea except perhaps one episode of loose stools after which he stops colchicine. Which is the most appropriate next step?
- A. Start Hydrochlorothiazide for hypertension
- B. Start Losartan for hypertension
- C. Stop Allopurinol during this acute gout attack and start colchicine
- D. Continue allopurinol at 100 mg OM despite the attack and start colchicine
Correct Answer: B
Rationale: Current gout attack with uric acid 405 mmol/L (above target <360) on allopurinol 200 mg suggests undertreatment. Continue allopurinol (not stop) during flares, add colchicine TDS for acute relief, and address BP 144/94 with Losartan urate-lowering and cardioprotective, unlike HCTZ, which raises urate. Check creatinine and up-titrate allopurinol later. This balances acute and chronic management effectively.
A client in the oncology clinic reports her family is frustrated at her ongoing fatigue 4 months after radiation therapy for breast cancer. What response by the nurse is most appropriate?
- A. Are you getting adequate rest and sleep each day?
- B. It is normal to be fatigued even for years afterward.
- C. This is not normal and I'll let the provider know.
- D. Try adding more vitamins B and C to your diet.
Correct Answer: B
Rationale: Radiation therapy, commonly used for breast cancer, can cause persistent fatigue as a side effect due to cellular damage and the body's prolonged healing process. This fatigue can last for months or even years post-treatment, varying by individual factors like radiation dose and overall health. Telling the client it's normal validates her experience, reduces anxiety, and helps her family understand this as a common outcome rather than a personal failing. Asking about rest is useful but doesn't address the family's frustration or provide context. Declaring it abnormal and escalating to the provider is inaccurate unless other symptoms suggest a new issue, potentially causing unnecessary worry. Suggesting vitamins lacks evidence for resolving radiation-induced fatigue and shifts focus from education. The nurse's role here is to reassure and educate, making the normalization of long-term fatigue the most appropriate response, fostering coping and support within the family.