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A postmenopausal client is experiencing low back and pelvic pain, fatigue, and bloody vaginal discharge. What laboratory tests would the nurse expect to see ordered for this client if endometrial cancer is suspected? (Select all that apply.)
- A. Cancer antigens (CA-125)
- B. White blood cell (WBC) count
- C. Hemoglobin and hematocrit (H&H)
- D. Prothrombin time (PT)
Correct Answer: A,C
Rationale: Serum tumor markers such as CA-125 assess for metastasis, especially if elevated. H&H would evaluate the possibility of anemia, a common finding with postmenopausal bleeding with endometrial cancer. WBC count is not indicated since there are no signs of infection. The INR and PT are coagulation tests to measure the time it takes for a fibrin clot to form, used to evaluate coagulation in clients receiving oral warfarin.
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A nurse is caring for four postoperative clients who each had a total abdominal hysterectomy. Which client should the nurse assess first upon initial rounding?
- A. Client who has a temperature of 99.6°F and a pulse of the last 2 hours
- B. Client with a temperature of 99.0°F and blood pressure of 115/73 mm Hg
- C. Client who has pain of 6 on a scale of 0 to 10
- D. Client with a urinary catheter output of 150 mL in the last 3 hours
Correct Answer: A
Rationale: None of vaginal bleeding should be less than one saturated perineal pad in 4 hours. Two saturated pads in such a short time could indicate hemorrhage, which is a priority. The other clients also have needs, but the client with excessive bleeding should be assessed first.
The client is emotionally upset about the recent diagnosis of stage IV endometrial cancer. Which action by the nurse is incorrect?
- A. Listen attentively to the client's concerns.
- B. Let the client alone for a long period of reflection time.
- C. Ask friends and relatives to limit their visits.
- D. Tell the client that an emotional response is unacceptable.
- E. Create an atmosphere of acceptance and discussion.
Correct Answer: D
Rationale: Discussion of a client's concerns about the presence of cancer and the potential for recurrence will provide emotional support and allay fears. Coping behaviors are encouraged with the support of friends and relatives. An emotional response should be accepted.
A client has recently been diagnosed with stage III endometrial cancer and asks the nurse for an explanation. What response by the nurse is correct about the staging of the cancer?
- A. The cancer has spread to the mucosa of the bowel and bladder.
- B. The cancer now involves the vagina or lymph nodes.
- C. The cancer now involves the cervix.
- D. The cancer is confined to the endometrium.
Correct Answer: B
Rationale: Stage III of endometrial cancer reaches the vagina or lymph nodes. Stage I is confined to the endometrium. Stage II involves the cervix, and stage IV spreads to the bowel or bladder mucosa and/or beyond the pelvis.
The nurse is teaching a client who is undergoing brachytherapy about what to immediately report to her health care provider. Which signs and symptoms would be included in this teaching? (Select all that apply.)
- A. Constipation for 3 days
- B. Severe diarrhea
- C. Abdominal pain
- D. Visible blood in the urine
- E. Heavy vaginal bleeding
Correct Answer: C,D,E
Rationale: Health teaching for a client having brachytherapy should emphasize reporting abdominal pain, visible blood in the urine, and heavy vaginal bleeding. Severe diarrhea, urethral burning, extreme fatigue, and a fever over 100°F should also be reported. Constipation for 3 days is not typically a critical symptom to report immediately in this context.
A client has scheduled brachytherapy sessions and states that she feels as though she is not safe around her family. What is the best response by the nurse?
- A. You are only radioactive when the radioactive implant is in place.
- B. To be totally safe, it is a good idea to sleep in a separate room.
- C. It is best to stay a safe distance from friends or family between treatments.
- D. You should use a separate bathroom from the rest of the family.
Correct Answer: A
Rationale: In brachytherapy, the surgeon inserts an applicator into the uterus. After placement is verified, the radioactive isotope is placed in the applicator for several minutes for a single treatment. There are no restrictions for the woman to stay away from her family or the public between treatments.