Nursing Elites

1. The nurse is instructing a client on ways to reduce the risk of lymphedema after a mastectomy. Which of the following should be emphasized?

• A. Elevate the affected arm
• B. Avoid lifting heavy objects
• C. Use compression garments as prescribed
• D. Avoid wearing tight clothing

Correct answer: D

Rationale: After a mastectomy, particularly when lymph nodes are removed, patients are at increased risk for developing lymphedema, which is a buildup of lymph fluid that can cause swelling in the affected arm. Wearing tight clothing can constrict lymphatic flow and increase the risk of developing lymphedema by impeding normal lymphatic drainage. Therefore, it is crucial to advise patients to avoid tight-fitting clothing, especially around the chest and arm areas.

2. Nurse Ben is reviewing the laboratory results of a client undergoing chemotherapy. Which of the following values would require immediate intervention?

• A. Platelet count of 150,000/mm3
• B. White blood cell count of 6,000/mm3
• C. Hemoglobin level of 14 g/dL
• D. Absolute neutrophil count of 500/mm3

Correct answer: D

Rationale: An absolute neutrophil count of 500/mm3 indicates severe neutropenia, putting the client at high risk for infection. Neutrophils are crucial in fighting off infections; a low count increases susceptibility to infections. Platelet count, white blood cell count, and hemoglobin levels are within normal ranges and do not require immediate intervention in this scenario.

3. 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.

4. An emergency department nurse is triaging a 77-year-old man who presents with uncharacteristic fatigue as well as back and rib pain. The patient denies any recent injuries. The nurse should recognize the need for this patient to be assessed for what health problem?

• A. Hodgkin disease
• B. Non-Hodgkin lymphoma
• C. Multiple myeloma
• D. Acute thrombocythemia

Correct answer: C

Rationale: The correct answer is multiple myeloma (choice C). Back pain is a common presenting symptom in multiple myeloma, especially in older patients. This malignancy can lead to bone pain due to bone destruction and fractures. Hodgkin disease (choice A) and Non-Hodgkin lymphoma (choice B) typically present with symptoms like painless lymph node enlargement, fever, and weight loss. Acute thrombocythemia (choice D) is characterized by an increase in platelet count but is not typically associated with the symptoms described by the patient.

5. The nurse is caring for a female client experiencing neutropenia as a result of chemotherapy and develops a plan of care for the client. The nurse plans to:

• A. Restrict all visitors
• B. Restrict fluid intake
• C. Teach the client and family about the need for hand hygiene
• D. Insert an indwelling urinary catheter to prevent skin breakdown

Correct answer: C

Rationale: In clients experiencing neutropenia due to chemotherapy, the immune system is significantly compromised, leaving the client highly susceptible to infections. Meticulous hand hygiene is one of the most effective ways to prevent infections in neutropenic patients. Teaching the client and their family the importance of frequent and proper handwashing helps reduce the transmission of harmful pathogens that could lead to severe infections in the neutropenic client. This simple but essential intervention is crucial in maintaining a safe environment.

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