Nokea
A woman has been using acupuncture to treat the nausea and vomiting caused by the side effects of chemotherapy for breast cancer. Which conditions would cause the nurse to recommend against further use of acupuncture? (Select all that apply.)
- A. Lymphedema
- B. Bleeding tendencies
- C. Low white blood cell count
- D. Elevated serum calcium
- E. High platelet count
Correct Answer: A,B,C
Rationale: Acupuncture is contraindicated in lymphedema due to poor drainage in the affected extremity, bleeding tendencies due to increased bleeding risk, and low white blood cell count due to infection risk. Elevated serum calcium and high platelet count do not contraindicate acupuncture.
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A client is discharged to home after a modified radical mastectomy with two drainage tubes. Which statement by the client would indicate that further teaching is needed?
- A. I can empty the drainage tubes daily and record the output.
- B. I should avoid lifting heavy objects with the affected arm.
- C. I can resume normal activities like swimming immediately.
- D. I will report any signs of infection, such as redness or swelling, to my provider.
Correct Answer: C
Rationale: The client should avoid strenuous activities like swimming until cleared by the provider to prevent complications such as lymphedema or infection. Emptying drainage tubes, avoiding heavy lifting, and reporting signs of infection are appropriate actions, indicating understanding.
A client is concerned about the risk of lymphedema after a mastectomy. Which response by the nurse is best?
- A. You do not need to worry about lymphedema since you did not have radiation therapy.
- B. A risk factor for lymphedema is infection, so wear gloves when gardening outside.
- C. Numbness, tingling, and swelling are common conditions after a mastectomy.
- D. The risk for lymphedema is a real threat and can be very self-limiting.
Correct Answer: B
Rationale: Infection can contribute to lymphedema, so wearing gloves during activities like gardening reduces this risk. Radiation is only one factor; others like obesity and axillary disease also contribute. Lymphedema symptoms are not common post-surgery, and while it is a concern, it is manageable with proper care.
A client is placed on a medical regimen of doxorubicin (Adriamycin), cyclophosphamide (Cytoxan), and another agent for breast cancer. What effect seen in the client should the nurse report to the provider immediately?
- A. Shortness of breath
- B. Hair loss
- C. Mucositis
- D. Vomiting
Correct Answer: A
Rationale: Doxorubicin (Adriamycin) can cause cardiac problems, with symptoms like shortness of breath indicating potential cardiotoxicity, which requires immediate reporting. Hair loss, mucositis, and vomiting are common chemotherapy side effects but are not immediately life-threatening.
A 37-year-old Nigerian woman is at high risk for breast cancer and is considering a prophylactic mastectomy and oophorectomy. What action by the nurse is most appropriate?
- A. Discourage this surgery since the woman is still of childbearing age.
- B. Reassure the client that reconstructive surgery is as easy as breast augmentation.
- C. Inform the client that this surgery removes all mammary tissue and cancer risk.
- D. Include support people, such as the male partner, in the decision making.
Correct Answer: D
Rationale: The cultural aspects of decision making need to be considered. In Nigerian culture, the man often plays a significant role in decision-making processes, so including support people like the male partner is appropriate to ensure culturally sensitive care.
A woman diagnosed with breast cancer had these laboratory tests performed at an office visit. Which test results indicate to the nurse that some further diagnoses are needed?
- A. The elevated alkaline phosphatase and calcium suggest bone involvement.
- B. Only alkaline phosphatase is decreased, suggesting liver metastasis.
- C. Hematocrit and hemoglobin are decreased, indicating anemia.
- D. The elevated hematocrit and hemoglobin indicate dehydration.
Correct Answer: A
Rationale: The alkaline phosphatase (normal 30 to 120 U/L) and total calcium (normal 9 to 10.5 mg/dL) levels are elevated (125 U/L and 12 mg/dL, respectively), suggesting bone metastasis. Hematocrit (19%) and hemoglobin (14 g/dL) are within normal limits for females, ruling out anemia or dehydration.