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Which of the following interventions would be best for the child who has developed mucositis as a side effect of chemotherapy?
- A. Using lemon glycerin swabs for oral hygiene.
- B. Keeping the child NPO until all sores are healed.
- C. Having the child swish and swallow viscous lidocaine.
- D. Giving the child pudding for breakfast.
Correct Answer: D
Rationale: Mucositis, a painful chemotherapy side effect, involves inflamed, ulcerated mucous membranes, often in the mouth, complicating eating and hygiene. Offering pudding a soft, bland, cool food is the best intervention, as it minimizes irritation and pain, encouraging nutrition without exacerbating sores. Lemon glycerin swabs are harsh, with citric acid and chemicals worsening discomfort and delaying healing. Keeping the child NPO (nothing by mouth) for weeks until sores heal is impractical and risks malnutrition, as mucositis can persist throughout chemotherapy. Viscous lidocaine might numb pain but is a last resort if the child refuses all intake, not a first-line comfort measure. Pudding supports hydration and calorie intake safely, aligning with nursing's goal to maintain nutrition and comfort in pediatric oncology, reducing mucositis-related distress effectively.
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A client is admitted with superior vena cava syndrome. What action by the nurse is most appropriate?
- A. Administer a dose of allopurinol (Aloprim).
- B. Assess the client's serum potassium level.
- C. Gently inquire about advance directives.
- D. Prepare the client for emergency surgery.
Correct Answer: C
Rationale: Superior vena cava syndrome (SVCS) occurs when cancer (often lung or lymphoma) obstructs the superior vena cava, impairing venous return from the head and upper body. It's often a late-stage manifestation with a poor prognosis, though treatable with radiation or stenting. After stabilizing the client (e.g., with oxygen, positioning), gently inquiring about advance directives is most appropriate, as it opens a compassionate discussion about goals of care amid a potentially terminal condition. Allopurinol and potassium levels relate to tumor lysis syndrome, not SVCS. Surgery is rare for SVCS, with non-invasive options preferred. This action respects the client's autonomy and prepares for realistic outcomes, aligning with oncology nursing's holistic approach to end-of-life care in advanced disease.
According to Johnson and Chang (2014) the role of the nurse and other health professions in chronic disease is to:
- A. Support the person in managing their condition more effectively
- B. Provide care to manage the disease process
- C. Ensure the patient takes their medications and avoids all risk factors
- D. Decide as a team on the best approach to manage the condition and direct the implementation of this care
Correct Answer: A
Rationale: Nurses in chronic care empower supporting self-management beats just treating, enforcing meds, or dictating plans. It's about patients steering their diabetes or asthma, with pros as guides, not bosses. Care's given, compliance nudged, teams plan, but support's the heart, a chronic win where autonomy rules.
It is the start of your second successive night shift on the labour ward. You have only managed to sleep for 4 h in the previous day. Your usual sleep requirement is 8 h per night. Appropriate statements regarding this situation include:
- A. Your total cumulative sleep deficit is 8 h.
- B. Your alertness will increase between 3 a.m. and 7 a.m. due to natural fluctuation in your circadian rhythm.
- C. Unintentional dural puncture during epidural insertion is more likely to occur during a night shift than during normal working hours.
- D. Sleeping for an extra 4 h will eliminate the sleep deficit.
Correct Answer: C
Rationale: Night shifts disrupt sleep and performance. After one night with 4 hours sleep (8-hour need), the deficit is 4 hours; a second night compounds it variably, but total' implies current state 8 hours overstates it without further context. Alertness dips 3-7 a.m. (circadian nadir), not increases, heightening fatigue. Night-shift studies (e.g., anaesthesia journals) show increased errors like dural puncture due to fatigue, reduced dexterity, and decision-making capacity, especially with sleep deprivation. Four extra hours reduce, not eliminate, a deficit if it's 4-12 hours cumulatively. Modafinil promotes wakefulness, not daytime sleep. The night-shift risk of dural puncture reflects fatigue's real-world impact on technical skills.
After receiving the hand-off report, which client should the oncology nurse see first?
- A. Client who is afebrile with a heart rate of 108 beats/min
- B. Older client on chemotherapy with mental status changes
- C. Client who is neutropenic and in protective isolation
- D. Client scheduled for radiation therapy today
Correct Answer: B
Rationale: In oncology nursing, prioritizing care is critical due to the complexity of cancer patients' conditions. An older client on chemotherapy with mental status changes is the priority because this could signal sepsis or infection, especially since chemotherapy-induced neutropenia often masks typical signs like fever in the elderly. Mental confusion might be the only early clue, and delayed assessment could lead to rapid deterioration or death. A heart rate of 108 beats/min without fever suggests tachycardia, possibly from dehydration or anxiety, but it's less urgent without other red flags. A neutropenic client in isolation needs monitoring, but no acute change is noted. The client scheduled for radiation has a planned treatment, not an immediate crisis. Assessing the older client first allows the nurse to rule out or address a life-threatening issue, aligning with the principle of prioritizing unstable patients in acute care settings.
A client is receiving treatment for the diagnosis of hemophilia A. Which of the following is the most appropriate to include in the assessment of this client?
- A. Cranial nerves
- B. Appetite
- C. Joint pain and bruising
- D. Urine output
Correct Answer: C
Rationale: Hemophilia A, a factor VIII deficiency, impairs clotting joint pain and bruising from hemarthrosis and bleeds are hallmark signs, demanding assessment to gauge bleeding severity and guide factor replacement. Cranial nerves check neurologic status, irrelevant unless bleeds hit the brain. Appetite or urine output offers general insight, not hemophilia-specific. Nurses zero in on joints and skin, tracking this genetic disorder's impact, critical for managing acute episodes and preventing long-term damage in this bleeding-prone client.