Question

The nurse is assessing a patient who has received the first dose of chemotherapy for leukemia. Which patient's clinical findings indicate to the nurse that the patient has developed tumor lysis syndrome (TLS)?

Answer 1

Correct Answers:

Flank pain, elevated uric acid, and cardiac monitor reveals an abnormal rhythm.

Rationale :

🟢 TLS Pathophysiology: Tumor Lysis Syndrome (TLS) occurs when large numbers of malignant cells lyse, releasing potassium, phosphate, and nucleic acids into the bloodstream.

🟢 Flank pain: Results from uric acid crystal deposition in the renal tubules, leading to acute kidney injury.

🟢 Hyperuricemia: Excess purines are metabolized into uric acid, causing renal impairment and metabolic disturbances.

🟢 Cardiac arrhythmias: Triggered by hyperkalemia due to massive intracellular potassium release.

🟢 Priority intervention: Aggressive IV hydration, allopurinol or rasburicase, and continuous cardiac monitoring.

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Answer 2

Correct Answers:

"This therapy will prevent me from getting hospital-acquired infections.”

Rationale :

🔵 Immunotherapy mechanism: Uses monoclonal antibodies, cytokines, or checkpoint inhibitors to enhance the immune system’s ability to recognize and attack cancer cells.

🔵 Limitation: It does not directly prevent unrelated bacterial or viral infections, including hospital-acquired types.

🔵 Side effects: May cause immune-related adverse events, such as colitis, hepatitis, or pneumonitis, requiring early detection.

🔵 Patient education: Focus on realistic treatment outcomes and the importance of infection precautions.

🔵 Care planning: Regular monitoring of CBC, liver function, and inflammatory markers is essential

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Answer 3

Correct Answers:

675

Rationale :

🟠 Step 1: Convert 198 lb to kg: 198 ÷ 2.2 = 90 kg.

🟠 Step 2: Multiply by dose: 90 × 15 mg/kg/day = 1350 mg/day.

🟠 Step 3: Divide by 2 for q12h dosing: 1350 ÷ 2 = 675 mg per dose.

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Answer 4

Correct Answers:

"I am able to sleep and rest at night.”

Rationale :

🟣 PTU mechanism: Propylthiouracil inhibits thyroid hormone synthesis and peripheral conversion of T4 to T3.

🟣 Symptom relief: Improved sleep reflects reduced metabolic rate, decreased anxiety, and diminished tachycardia.

🟣 Other improvements: Weight stabilization, reduced heat intolerance, and normalized bowel patterns.

🟣 Monitoring: Assess TSH and free T4 to guide therapy adjustments.

🟣 Long-term management: Therapy may be continued for 12–18 months, with risk of recurrence discussed.

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Answer 5

Correct Answers:

Increase of 25 mmHg in the patient's systolic blood pressure.

Rationale :

🟡 Addisonian crisis: Results from acute cortisol deficiency, leading to severe hypotension and shock.

🟡 Treatment effect: IV hydrocortisone restores vascular tone and sensitivity to catecholamines.

🟡 BP improvement: Rise in systolic BP signals effective crisis reversal.

🟡 Electrolyte effects: Cortisol also helps normalize sodium and lower potassium levels.

🟡 Follow-up: Continue stress-dose steroids until patient stabilizes.

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Answer 6

Correct Answers:

5

Rationale :

🔴 Order analysis: 0.5 mg levothyroxine = 500 mcg.

🔴 Infusion rate: 100 mcg/min → 500 ÷ 100 = 5 min total.

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Answer 7

Correct Answers:

Calcitonin 300 international units subcutaneous.

Rationale :

🟤 Indication: Severe hypercalcemia from hyperparathyroidism or malignancy.

🟤 Mechanism: Calcitonin inhibits osteoclast activity, reducing bone resorption and promoting renal calcium excretion.

🟤 Benefit: Works rapidly, making it ideal for acute calcium lowering.

🟤 Adjuncts: Combine with hydration and bisphosphonates for sustained control.

🟤 Monitoring: Serial calcium levels and symptom improvement.

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Answer 8

Correct Answers:

Implement bleeding precautions and administer platelet transfusion.

Rationale :

🟢 Critical level: Platelets at 6,000/mm³ indicate severe thrombocytopenia.

🟢 Risk: Danger of spontaneous intracranial hemorrhage or GI bleeding.

🟢 Precautions: Avoid invasive procedures, maintain soft oral care, no IM injections.

🟢 Treatment: Immediate platelet transfusion if <10,000/mm³ or active bleeding.

🟢 Follow-up: Reassess counts after transfusion to guide next steps.

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Answer 9

Correct Answers:

"I will stay away from people with infections and call my healthcare provider if I develop a fever.” .

Rationale :

🔵 Cause: Cushing’s syndrome from prolonged corticosteroid exposure suppresses immune function.

🔵 Risk: Increased vulnerability to bacterial, viral, and fungal infections.

🔵 Prevention: Limit contact with sick individuals, maintain strict hygiene.

🔵 Action: Fever should prompt immediate evaluation due to sepsis risk.

🔵 Education: Continue monitoring for hypertension, hyperglycemia, and osteoporosis.

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Answer 10

Correct Answers:

Educate the patient about the need for routine mammography screening.

Rationale :

🟠 Surveillance: Post-treatment patients remain at risk for recurrence or new primary cancers.

🟠 Mammography: Annual or provider-recommended imaging detects early lesions.

🟠 Importance: Early detection improves survival and reduces treatment burden.

🟠 Patient role: Education empowers self-advocacy and adherence.

🟠 Holistic care: Include psychosocial support, exercise, and diet counseling.

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Med surg Exam-Montgomery College

No.

1 :
The nurse is assessing a patient who has received the first dose of chemotherapy for leukemia. Which patient's clinical findings indicate to the nurse that the patient has developed tumor lysis syndrome (TLS)?

2 :
The nurse is caring for a patient with recurrent prostate cancer who is scheduled to begin treatment with immunotherapy medication. During patient teaching, which statement by the patient will indicate a need for further teaching by the nurse?

4 :
The nurse is evaluating a patient with hyperthyroidism who is taking propylthiouracil (PTU) 100 mg/day for maintenance therapy. Which statement from the patient indicates the medication therapy is effective?

5 :
The nurse is caring for a patient who was treated for Addisonian crisis. What clinical change indicates to the nurse that the prescribed therapy was effective?

9 :
The nurse is providing discharge teaching to a patient diagnosed with Cushing's syndrome. What statement made by the patient will demonstrate their understanding of the discharge instructions?

10 :
The nurse is caring for a patient who has been in remission from breast cancer for five years. What intervention will the nurse include as a component of survivorship care for this patient?

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Med surg Exam-Montgomery College

No.

1 : The nurse is assessing a patient who has received the first dose of chemotherapy for leukemia. Which patient's clinical findings indicate to the nurse that the patient has developed tumor lysis syndrome (TLS)?

2 : The nurse is caring for a patient with recurrent prostate cancer who is scheduled to begin treatment with immunotherapy medication. During patient teaching, which statement by the patient will indicate a need for further teaching by the nurse?

4 : The nurse is evaluating a patient with hyperthyroidism who is taking propylthiouracil (PTU) 100 mg/day for maintenance therapy. Which statement from the patient indicates the medication therapy is effective?

5 : The nurse is caring for a patient who was treated for Addisonian crisis. What clinical change indicates to the nurse that the prescribed therapy was effective?

9 : The nurse is providing discharge teaching to a patient diagnosed with Cushing's syndrome. What statement made by the patient will demonstrate their understanding of the discharge instructions?

10 : The nurse is caring for a patient who has been in remission from breast cancer for five years. What intervention will the nurse include as a component of survivorship care for this patient?

1 :
The nurse is assessing a patient who has received the first dose of chemotherapy for leukemia. Which patient's clinical findings indicate to the nurse that the patient has developed tumor lysis syndrome (TLS)?

2 :
The nurse is caring for a patient with recurrent prostate cancer who is scheduled to begin treatment with immunotherapy medication. During patient teaching, which statement by the patient will indicate a need for further teaching by the nurse?

4 :
The nurse is evaluating a patient with hyperthyroidism who is taking propylthiouracil (PTU) 100 mg/day for maintenance therapy. Which statement from the patient indicates the medication therapy is effective?

5 :
The nurse is caring for a patient who was treated for Addisonian crisis. What clinical change indicates to the nurse that the prescribed therapy was effective?

9 :
The nurse is providing discharge teaching to a patient diagnosed with Cushing's syndrome. What statement made by the patient will demonstrate their understanding of the discharge instructions?

10 :
The nurse is caring for a patient who has been in remission from breast cancer for five years. What intervention will the nurse include as a component of survivorship care for this patient?