Nokea
The nurse is caring for a client following a mastectomy. Which nursing intervention would assist in preventing lymphedema of the affected arm?
- A. Placing cool compresses on the affected arm
- B. Elevating the affected arm on a pillow above heart level
- C. Avoiding arm exercises in the immediate postoperative period
- D. Maintaining an intravenous site below the antecubital area on the affected side
Correct Answer: B
Rationale: After a mastectomy, particularly when lymph nodes are removed, there is an increased risk of lymphedema in the affected arm due to impaired lymphatic drainage. Elevating the affected arm above heart level helps promote lymphatic drainage and reduces the risk of swelling. This intervention facilitates the return of lymph fluid and helps prevent fluid accumulation in the arm.
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A nurse at a long-term care facility is amending the care plan of a resident who has just been diagnosed with essential thrombocythemia (ET). The nurse should anticipate the administration of what medication?
- A. Dalteparin
- B. Allopurinol
- C. Hydroxyurea
- D. Hydrochlorothiazide
Correct Answer: C
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
A nurse is preparing to administer filgrastim to a client undergoing chemotherapy. What is the primary purpose of this medication?
- A. Increase white blood cell production.
- B. Reduce the risk of infection.
- C. Enhance red blood cell production.
- D. Control chemotherapy-induced nausea and vomiting.
Correct Answer: A
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
The nurse is caring for a 39-year-old woman with a family history of breast cancer. She requested a breast tumor marking test and the results have come back positive. As a result, the patient is requesting a bilateral mastectomy. This surgery is an example of what type of oncologic surgery?
- A. Salvage surgery
- B. Palliative surgery
- C. Prophylactic surgery
- D. Reconstructive surgery
Correct Answer: C
Rationale: Prophylactic surgery refers to the preventive removal of tissues or organs at high risk for developing cancer, even when no cancer is currently present. In this case, the patient has a positive breast tumor marking test and a significant family history of breast cancer, which places her at increased risk for developing the disease. A bilateral mastectomy is performed to significantly reduce this risk by removing both breasts, thereby preventing the potential future occurrence of breast cancer.
Four clients are receiving tyrosine kinase inhibitors (TKIs). Which of these four clients would the nurse assess first?
- A. Dry, itchy, peeling skin.
- B. Serum calcium of 9.2 mg/dL (2.3 mmol/L).
- C. Serum potassium of 2.8 mEq/L (2.8 mmol/L).
- D. Weight gain of 0.5 lb (1.1 kg) in 1 day.
Correct Answer: C
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
A nurse knows that all of the following are managements of breast cancer except:
- A. Administer chemotherapy as ordered
- B. Let the patient lie down with 1-2 pillows
- C. Give patient Tamoxifen as ordered
- D. Let the patient elevate affected arm post op
Correct Answer: B
Rationale: In the management of breast cancer, particularly after procedures such as a mastectomy, it is important to position the patient in a way that promotes healing and comfort. However, lying down with 1-2 pillows is not a standard practice for postoperative care. Instead, patients are often advised to elevate the affected arm to reduce swelling and promote drainage, and they may benefit from sleeping in a more upright position if they are experiencing discomfort. The focus should be on facilitating recovery rather than simply lying down.