Nokea
A client had a left radical mastectomy with an axillary node dissection 6 months ago and is having a large amount of edema in the left arm down to the fingers. What should the nurse inform the client is the reason for the edema?
- A. An accumulation of lymphatic fluid that results from impaired lymph circulation.
- B. It is congenitally acquired and is not related to the mastectomy.
- C. They are most likely ingesting too much sodium and should be advised to decrease the amount.
- D. There is inadequate blood flow from circulatory impairment.
Correct Answer: A
Rationale: Lymphedema is an accumulation of lymphatic fluid that results from impaired lymph circulation. It is a complication resulting from the removal of multiple lymph nodes at the time of mastectomy or radiation for cancer. It may be congenitally acquired, but in this situation, it is secondary and related to the mastectomy. Sodium intake would not be related to the accumulation of lymph fluid and would be generalized. There is not circulatory impairment from decreased blood flow but impaired lymphatic flow.
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The client is receiving chemotherapy for a diagnosis of lymphosarcoma. The client experiences nausea. What measures should the nurse suggest to help the client reduce the feeling of nausea?
- A. Administer immunosuppressive drugs.
- B. Apply ice to the skin for brief periods.
- C. Offer clear liquids such as carbonated beverages, water, and ice pops.
- D. Advise bed rest as much as possible.
Correct Answer: C
Rationale: To help reduce the feeling of nausea in a client who underwent chemotherapy, the nurse should offer clear liquids such as carbonated beverages, water, ice pops, and gelatin until the nausea subsides. Immunosuppressive drugs are known to cause non-Hodgkin's lymphoma when administered to prevent a transplant rejection. These drugs do not help in reducing the feeling of nausea. The nurse may need to apply ice to the skin to prevent it from itching and thereby promote the skin integrity. Bed rest, analgesic and antipyretic therapy, and increased fluid intake are recommended to clients with infectious mononucleosis.
A client with lymphedema of the left leg has a nursing diagnosis of Altered Body Image Perception related to lymphedema of the left leg as evidenced by the statement, 'I look terrible and am embarrassed to go out.' What intervention can the nurse provide to help this client?
- A. Inform the client it is acceptable to stay away from social activities.
- B. Encourage the client to go out and socialize despite not wanting to
- C. Suggest certain styles of clothing that conceal the enlargement of the leg.
- D. Refer the client to a psychiatrist.
Correct Answer: C
Rationale: Extensive emotional support is necessary when the edema is severe. The client's self-esteem often is decreased, which can lead to social withdrawal. The nurse supports the client's self-image by suggesting certain styles of clothing that conceal abnormal enlargement of an arm or leg. Informing the client to stay away from social activities can create a depressed mood and loneliness. The client should not be encouraged to go out and socialize if not ready nor referred to a psychiatrist at this point.
Which client does the nurse recognize as most likely to be diagnosed with non-Hodgkin's lymphoma rather than Hodgkin's lymphoma?
- A. A 55-year-old client with an immunosuppression disorder
- B. A 35-year-old client with type 2 diabetes mellitus
- C. A 20-year-old client with infectious mononucleosis
- D. A 40-year-old client with Reed-Sternberg cells in an axillary lymph node
Correct Answer: A
Rationale: Non-Hodgkin's lymphoma peak onset is after 50 years and is common among clients with immune suppression. There is no correlation with client that has diabetes and non-Hodgkin's lymphoma. Forty percent of affected clients test positive for Epstein-Barr virus that causes infectious mononucleosis and that test positive for Reed-Sternberg cells in the lymph nodes that are correlated with Hodgkin's lymphoma.
The nurse is caring for a client in the hospital who is being treated for Hodgkin's disease and is taking a chemotherapeutic regimen in the hospital's oncology unit. When reviewing the client's medication history, what regimen does the nurse recognize as the drugs in the treatment of Hodgkin's disease?
- A. Ceftriaxone, furosemide, rifampin, ibuprofen
- B. Doxorubicin, bleomycin, vinblastine, dacarbarine
- C. Albuterol, ipratropium, methylprednisolone, acetylcysteine
- D. Enalapril, atenolol, verapamil, lovastatin
Correct Answer: B
Rationale: Doxorubicin, bleomycin, vinblastine, and dacarbarine are a combination of medications for the chemotherapeutic treatment of Hodgkin's disease. There are several different regimens that may be used but the medications in the other options are not used for the treatment of Hodgkin's disease.
The nurse is providing instruction on the use of compression garments for the client with lymphedema. What should be included in the instructions? Select all that apply.
- A. Purchase two compression garments.
- B. Change the garment in the morning and in the evening.
- C. Limit the time the garment is not worn to 30 to 60 minutes.
- D. Replace a compression garment every month.
- E. Place the garment in the dryer after washing
Correct Answer: A,B,C
Rationale: When instructing the client on use of the compression garment, purchase two compression garments so that one can be worn while the other is washed and dried. Change the garment in the morning and again in the evening because the garment becomes stretched after 12 hours of being worn. Limit the time that the garment is not worn to no more than 30 to 60 minutes to prevent re accumulation of tissue fluid and stretched skin. The garment should be replaced every 4 to 6 months, not every month. The garment should be air dried, not placed in the dryer.