A patient with advanced leukemia is responding poorly to treatment. The nurse finds the patient tearful and trying to express his feelings, but he is clearly having difficulty. What is the nurses most appropriate action?

Correct Answer: C

Rationale: In this scenario, the most appropriate action for the nurse is option C: Ask if he would like you to sit with him while he collects his thoughts. This response demonstrates empathy, active listening, and a willingness to provide emotional support to the patient. Option A is incorrect as it dismisses the patient's emotional distress and fails to address his needs. Option B, offering to call pastoral care, may be appropriate but does not directly address the patient's immediate need for support in that moment. Option D, telling the patient that you can understand how he's feeling, while well-intentioned, may come off as dismissive or presumptive of the patient's emotions. Educationally, this question highlights the importance of therapeutic communication and empathy in nursing care, especially in oncology and palliative settings where patients often experience intense emotional distress. Nurses must be equipped with skills to provide emotional support and create a safe space for patients to express their feelings during difficult times.

Correct Answer: A

Rationale: In the context of caring for a patient with Hodgkin lymphoma, the main goal of care is typically the cure of the disease. Hodgkin lymphoma is a type of cancer that can be curable, especially when diagnosed and treated in the early stages. The primary focus of treatment is to achieve a complete remission and cure the patient of the cancer. Option B, enhancing quality of life, is an important aspect of oncology nursing care but may not always be the main goal when dealing with a curable cancer like Hodgkin lymphoma. In this case, the priority is often on achieving a cure rather than solely focusing on quality of life. Option C, controlling symptoms, and option D, palliation, are more relevant in the context of managing advanced or terminal cancers where the main goal may shift towards symptom management and improving quality of life rather than aiming for a cure. In an educational context, it is crucial for nurses to understand the specific goals of care for different types of cancers to provide appropriate and effective care to their patients. Recognizing the main goal of care for a particular cancer helps nurses prioritize interventions and outcomes to best meet the needs of the patient.

Correct Answer: D

Rationale: In the context of acute myeloid leukemia (AML), the correct answer is D) An aggressive course of chemotherapy. This is because induction therapy for AML typically involves a combination of chemotherapy agents to rapidly reduce the number of leukemia cells in the body and induce a remission. Chemotherapy is the standard first-line treatment for AML and aims to eradicate cancer cells in the bone marrow and blood. Option A) Daily treatment with targeted therapy medications is not typically used as the primary induction therapy for AML. Targeted therapy may be used in specific cases or as a maintenance therapy after initial treatment. Option B) Radiation therapy is not a standard first-line treatment for AML. It is more commonly used in specific situations such as central nervous system involvement or palliative care. Option C) Hematopoietic stem cell transplantation (HSCT) is not typically part of the initial induction therapy for AML. HSCT is usually considered after achieving remission with induction therapy in order to prevent relapse or for patients with high-risk disease. Understanding the rationale behind the choice of treatment in AML is crucial for nurses caring for patients undergoing cancer therapy. It helps them provide accurate information to patients, manage side effects effectively, and support patients through their treatment journey.

Correct Answer: B

Rationale: In the context of pharmacology, understanding the characteristic assessment findings of different types of leukemia is crucial for accurate diagnosis and treatment planning. In this scenario, the correct answer is B) Increased lymphocyte levels. Chronic lymphocytic leukemia (CLL) is characterized by the proliferation of abnormal, mature-appearing lymphocytes in the blood and bone marrow. This leads to elevated lymphocyte levels in the peripheral blood, which is a hallmark feature of CLL. Option A) Increased numbers of blast cells is more indicative of acute leukemias such as acute myeloid leukemia (AML) or acute lymphoblastic leukemia (ALL), where blast cells are immature and rapidly dividing. CLL, being a chronic leukemia, is characterized by the accumulation of mature but abnormal lymphocytes, not blast cells. Option C) Intractable bone pain is not typically associated with CLL. Bone pain may be seen in conditions like multiple myeloma or bone metastases, but it is not a typical finding in CLL. Option D) Thrombocytopenia with no evidence of bleeding is not a specific feature of CLL. Thrombocytopenia (low platelet count) can occur in various conditions, including different types of leukemia, but it is not a defining characteristic of CLL. Educationally, this question emphasizes the importance of recognizing key clinical manifestations of specific types of leukemia to differentiate between them accurately. Understanding these distinctions is vital for healthcare providers when assessing and managing patients with hematologic malignancies.

Correct Answer: C

Rationale: In this scenario, option C, which is to assess the patient's specific needs for education and support, is the most appropriate response to meet the psychosocial needs of a patient newly diagnosed with acute lymphocytic leukemia. Educational Context: Assessing the patient's specific needs for education and support is crucial in providing holistic care to individuals with a cancer diagnosis. It allows the nurse to tailor information and resources to address the patient's unique concerns, fears, and knowledge gaps, promoting informed decision-making and enhancing coping mechanisms. Why Option C is Correct: By assessing the patient's specific needs for education and support, the nurse can identify areas where the patient requires additional information, emotional support, or resources to navigate their diagnosis and treatment effectively. This proactive approach helps to address the patient's immediate distress and empowers them to actively participate in their care. Why Other Options are Incorrect: - Option A: Assessing the patient's previous experience with the health care system is important but does not directly address the immediate psychosocial needs expressed by the patient. - Option B: While providing reassurance is essential, simply stating that treatment will be successful may not be sufficient to address the patient's current emotional distress and lack of direction. - Option D: Identifying the patient's plan of medical care is important but does not directly address the patient's psychosocial needs or emotional state following the diagnosis.