Immune/Cancer Review
A client with lung cancer receiving chemotherapy tells the nurse that the food on the meal tray tastes "funny." Which is the appropriate nursing intervention? 1. Keep the client NPO. 2. Provide oral hygiene care frequently. 3. Administer an antiemetic as prescribed. 4. Consult with other health care providers regarding a prescription for parenteral nutrition.
2 Chemotherapy may cause distortion of taste. Frequent oral hygiene aids in preserving taste function. Keeping a client NPO increases nutritional risks. Antiemetics are used when nausea and vomiting are a problem. Parenteral nutrition is used when oral intake is not possible.
The nurse is assisting with conducting a health-promotion program to community members regarding testicular cancer. The nurse determines the need for further teaching if a community member states that which is a sign/symptom of testicular cancer? 1. Alopecia 2. Back pain 3. Painless testicular swelling 4. A heavy sensation in the scrotum
1 Alopecia is not a sign/symptom of testicular cancer. However, it may occur as a result of radiation or chemotherapy. Options 2, 3, and 4 are findings in clients with testicular cancer. Back pain may indicate metastasis to the retroperitoneal lymph nodes.
A client with liver cancer who is receiving chemotherapy tells the nurse that some foods on the meal tray taste bitter. The nurse should try to limit which food that is most likely to have this taste for the client? 1. Beef 2. Custard 3. Potatoes 4. Cantaloupe
1 Chemotherapy may cause distortion of taste. Frequently, beef and pork are reported to taste bitter or metallic. The nurse can promote client nutrition by assisting the client to choose alternative sources of protein in the diet. The food items in options 2, 3, and 4 are not likely to cause distortion of taste.
A health care provider aspirates synovial fluid from a knee joint of a client with rheumatoid arthritis. The nurse reviews the laboratory analysis of the specimen and should expect the results to indicate which finding? 1. Cloudy synovial fluid 2. Presence of organisms 3. Bloody synovial fluid 4. Presence of urate crystals
1 Cloudy synovial fluid is diagnostic of rheumatoid arthritis. Organisms present in the synovial fluid are characteristic of a septic joint condition. Bloody synovial fluid is seen with trauma. Urate crystals are found in gout.
The nurse is reviewing the laboratory results of a client who has been diagnosed with multiple myeloma. Which finding should the nurse expect to note with this diagnosis? 1. Increased calcium level 2. Increased white blood cells 3. Decreased blood urea nitrogen (BUN) level 4. Decreased number of plasma cells in the bone marrow
1 Findings that are indicative of multiple myeloma are an increased number of plasma cells in the bone marrow, anemia, hypercalcemia as a result of the release of calcium from the deteriorating bone tissue, and an elevated BUN level. An increased white blood cell count may or may not be present, but this is not specifically related to multiple myeloma.
The nurse determines that the neutropenic client needs further teaching if which statement is made by the client? 1. "I will include plenty of fresh fruits in my diet." 2. "If I develop a fever over 100° F, I will call my doctor." 3. "Petting my dog is fine as long as I wash my hands after doing so." 4. "My husband will just have to take over cleaning the cat's litter box."
1 Fresh fruits and vegetables are eliminated from the diet to avoid the introduction of pathogens. Fever of 100.4° F or greater should be reported immediately. Feeding and petting cats and dogs are fine as long as hand washing follows. Handling pet excrement must be avoided to avoid exposure to pathogens.
The nurse is assisting with developing a plan of care for the client with multiple myeloma. Which is a priority nursing intervention for this client? 1. Encouraging fluids 2. Providing frequent oral care 3. Coughing and deep breathing 4. Monitoring the red blood cell count
1 Hypercalcemia secondary to bone destruction is a priority concern in the client with multiple myeloma. The nurse should encourage fluids in adequate amounts to maintain an output of 1.5 to 2 L/day. Clients require about 3 L of fluid per day. The fluid is needed not only to dilute the calcium but also to prevent protein from precipitating in the renal tubules. Options 2, 3, and 4 may be components of the plan of care, but they are not the priorities for this client.
The community health nurse is conducting a research study and is identifying clients in the community who are at risk for latex allergy. Which client population is at risk for developing this type of allergy? 1. Hairdressers 2. The homeless 3. Children in day care centers 4. Individuals living in a group home
1 Individuals at risk for developing a latex allergy include health care workers; individuals who work in the rubber industry; individuals having multiple surgeries; individuals with spina bifida; individuals who wear gloves frequently such as food handlers, hairdressers, and auto mechanics; and individuals allergic to kiwis, bananas, pineapples, tropical fruits, grapes, avocados, potatoes, hazelnuts, and water chestnuts.
The camp nurse prepares to instruct a group of children about Lyme disease. Which information should the nurse include in the instructions? 1. Lyme disease is caused by a tick carried by deer. 2. Lyme disease is caused by contamination from cat feces. 3. Lyme disease can be contagious by skin contact with an infected individual. 4. Lyme disease can be caused by the inhalation of spores from bird droppings.
1 Lyme disease is a multisystem infection that results from a bite by a tick carried by several species of deer. Persons bitten by Ixodes ticks can be infected with the spirochete Borrelia burgdorferi. Lyme disease cannot be transmitted from one person to another. Toxoplasmosis is caused from the ingestion of cysts from contaminated cat feces. Histoplasmosis is caused by the inhalation of spores from bat or bird droppings.
The nurse is caring for a client in the oncology unit who has developed stomatitis during chemotherapy. The nurse should plan which measure to treat this complication? 1. Rinse the mouth with dilute baking soda or saline solution. 2. Use lemon and glycerin swabs liberally on painful oral lesions. 3. Brush the teeth and use nonwaxed dental floss at least twice a day. 4. Place the client on nothing-by-mouth (NPO) status for 12 hours, and then resume liquids.
1 Stomatitis, or mouth ulcerations, occurs with the administration of many antineoplastic medications. The client's mouth should be examined daily for signs of ulceration. If stomatitis occurs, the client should be instructed to rinse the mouth with dilute baking soda or saline solution. Food and fluids are important and should not be restricted. If chewing and swallowing are painful, the client may switch to a liquid diet. The client is instructed to avoid spicy foods and foods with hard crusts or edges. The client should avoid tooth brushing and flossing when stomatitis is severe. Lemon and glycerin swabs may cause pain and further irritation.
A cervical radiation implant is placed in the client for treatment of cervical cancer. Which activity would the nurse most likely expect to note in the health care provider's prescriptions? 1. Bed rest 2. Out of bed in a chair 3. Ambulate to the bathroom 4. Out of bed and up to the bedside commode
1 The client with a cervical radiation implant should be maintained on bed rest in the dorsal position to prevent movement of the radiation source. The head of the bed is elevated to a maximum of 10 to 15 degrees for comfort. Turning the client onto her side is avoided. If the client needs to be turned, a pillow is placed between the knees and, with the body in straight alignment, the client is logrolled.
The nurse reviews the care plan of a client with cancer and notes that the client has a problem with adequate food intake related to side effects of therapy. In order to enhance appetite and nutrition, the nurse should offer which advice to the client? 1. Avoid strong-smelling foods. 2. Avoid small, frequent meals. 3. Avoid foods containing lean animal protein. 4. Avoid foods that are served at room temperature.
1 The client with cancer is advised to avoid strong-smelling foods that may aggravate anorexia or be distasteful to the client. The client should increase intake of calories and sources of lean protein. The client should also eat small, frequent meals. Foods that are near room temperature, or that are neither too hot nor too cold, are better tolerated by the client. Other measures that can help improve appetite include rinsing the mouth before eating and dining in an aesthetically pleasing environment.
The nurse is assisting in planning care for a client with a diagnosis of immune deficiency. The nurse should incorporate which as a priority in the plan of care? 1. Protecting the client from infection 2. Providing emotional support to decrease fear 3. Encouraging discussion about lifestyle changes 4. Identifying factors that decreased the immune function
1 The client with immune deficiency has inadequate or absent immune bodies and is at risk for infection. The priority nursing intervention would be to protect the client from infection. Options 2, 3, and 4 may be components of care but are not the priority.
The nurse is reinforcing dietary instructions to a client with systemic lupus erythematosus. Which dietary items should the nurse instruct the client to avoid? 1. Steak 2. Turkey 3. Broccoli 4. Cantaloupe
1 The client with systemic lupus erythematosus is at risk for cardiovascular disorders such as coronary artery disease and hypertension. The client is advised of lifestyle changes to reduce these risks, which include smoking cessation and prevention of obesity and hyperlipidemia. The client is advised to reduce salt, fat, and cholesterol intake.
The nurse is reinforcing instructions to a community group regarding the risks and causes of bladder cancer. The nurse determines that there is a need for further teaching if a member of the community group makes which statement regarding this type of cancer? 1. It most often occurs in women. 2. It is generally seen in clients who are older than 40 years of age. 3. Environmental health hazards have been found to be a cause of this disease. 4. Using cigarettes, artificial sweeteners, and coffee drinking can increase the risk for this cancer.
1 The incidence of bladder cancer is three times greater among men than among women, and it affects the white population twice as often as the black population. The remaining options are associated with the incidence of bladder cancer.
The nurse is obtaining data from a client admitted with a diagnosis of bladder cancer. Which question should the nurse ask the client to determine if the client experienced the common symptom associated with this type of cancer? 1. "Do you notice any blood in the urine?" 2. "Do you have frequency with urination?" 3. "Do you commonly feel the urge to urinate?" 4. "Do you experience any pain when you urinate?"
1 The most common symptom in clients with cancer of the bladder is hematuria. The client may also experience irritative voiding symptoms such as frequency, urgency, and dysuria, which often are associated with cancer in situ. The nurse's question in option 4 will elicit information from the client regarding the most common symptom associated with bladder cancer.
The nurse reinforces instructions to the client about breast self-examination (BSE). The nurse instructs the client to lie down and examine the left breast. Which is the correct area for placing a pillow when examining the left breast? 1. Under the left shoulder 2. Under the right scapula 3. Under the right shoulder 4. Under the small of the back
1 The nurse would instruct the client to lie down and place a towel or pillow under the shoulder on the side of the breast to be examined. If the left breast is to be examined, the pillow would be placed under the left shoulder. Options 2 and 4 are incorrect.
The home care nurse is assigned to care for a client who returned home from the emergency department following treatment for a sprained ankle. The nurse notes that the client was sent home with crutches that have rubber axillary pads and needs to reinforce instructions regarding crutch walking. On data collection, the nurse discovers that the client has an allergy to latex. Before providing instructions regarding crutch walking, the nurse should do which? 1. Cover the crutch pads with cloth. 2. Contact the health care provider (HCP). 3. Call the local medical supply store, and ask for a cane to be delivered. 4. Tell the client that the crutches must be removed immediately from the house.
1 The rubber pads used on crutches may contain latex. If the client requires the use of crutches, the nurse can cover the pads with a cloth to prevent cutaneous contact. Telling the client that the crutches must be immediately removed from the house is inappropriate and may alarm the client. The nurse cannot prescribe a cane for a client. In addition, this type of assistive device may not be appropriate, considering this client's injury. No reason exists to contact the HCP at this time.
The nurse is caring for a client with an internal radiation implant. The nurse should observe which principle? 1. Pregnant women are not allowed into the client's room. 2. Limit the time with the client to 1 hour per 8-hour shift. 3. Remove the dosimeter badge when entering the client's room. 4. Individuals less than 16 years old are allowed in the room if they stay 6 feet away from the client.
1 The time that the nurse spends in the room of a client with an internal radiation implant is 30 minutes per 8-hour shift. The dosimeter badge must be worn when in the client's room. Children less than 16 years old and pregnant women are not allowed in the client's room. These guidelines protect individuals from radiation exposure.
A client with cancer is receiving chemotherapy and develops thrombocytopenia. Which intervention is a priority in the nursing plan of care? 1. Monitor the client for bleeding. 2. Monitor the client's temperature. 3. Ambulate the client three times daily. 4. Monitor the client for pathological fractures.
1 Thrombocytopenia indicates a decrease in the number of platelets in the circulating blood. A major concern is monitoring for and preventing bleeding. Monitoring the temperature relates to infection, particularly if leukopenia is present. The options indicating to ambulate the client and monitor for pathological fractures are also important to the plan of care but are not directly related to thrombocytopenia.
The nurse is assisting in identifying clients in the community at risk for latex allergy. Which client population is most at risk for developing this type of allergy? 1. Children in day care centers 2. Individuals with spina bifida 3. Individuals with cardiac disease 4. Individuals living in a group home
2 Individuals at risk for developing a latex allergy include health care workers; individuals who work with manufacturing latex products; individuals with spina bifida; individuals who wear gloves frequently such as food handlers, hairdressers, and auto mechanics; and individuals allergic to kiwis, bananas, pineapples, passion fruit, avocados, and chestnuts.
The nurse reinforces home care instructions to a client with systemic lupus erythematosus and tells the client about methods to manage fatigue. Which statement by the client indicates a need for further teaching? 1. "I should take hot baths because they are relaxing." 2. "I should sit whenever possible to conserve my energy." 3. "I should avoid long periods of rest because it causes joint stiffness." 4. "I should do some exercises, such as walking, when I am not fatigued."
1 To help reduce fatigue in the client with systemic lupus erythematosus, the nurse should instruct the client to sit whenever possible, avoid hot baths (because they exacerbate fatigue), schedule moderate low-impact exercises when not fatigued, and maintain a balanced diet. The client is instructed to avoid long periods of rest because it promotes joint stiffness.
The nurse is assisting in developing a plan of care for a pregnant client with acquired immunodeficiency syndrome (AIDS). The nurse determines that which concern is the priority for this client? 1. Isolation 2. Development of an infection 3. Inability to care for herself at home 4. Lack of available support services
2 Acquired immunodeficiency syndrome decreases the body's immune response, making the infected person susceptible to infections. AIDS affects helper T lymphocytes, which are vital to the body's defense system. Opportunistic infections are a primary cause of death in people affected with AIDS. Therefore, preventing infection is a priority of nursing care. Although the concerns in options 1, 3, and 4 may need to be addressed at some point in the care of the client, these are not priorities.
The nurse is caring for a client after a mastectomy. Which nursing intervention should assist with preventing lymphedema of the affected arm? 1. Placing cool compresses on the affected arm 2. Elevating the affected arm on a pillow above heart level 3. Avoiding arm exercises during the immediate postoperative period 4. Maintaining an intravenous (IV) insertion site below the antecubital area on the affected side
2 After mastectomy, the health care provider's prescriptions regarding positioning are followed. The arm on the surgical side is usually elevated above the level of the heart, and simple arm exercises should be encouraged. No blood pressure readings, injections, IV line insertions, or blood draws should be performed on the affected arm. Cool compresses are not a recommended measure to prevent lymphedema from occurring.
The nurse should monitor for which laboratory result as indicating an adverse reaction in the client with endometrial cancer who is receiving chemotherapy? 1. Hemoglobin 12.5 g/dL 2. Platelet count 20,000 cells/mm3 3. Blood urea nitrogen 20 mg/dL 4. White blood cell count 7000 cells/mm3
2 A normal platelet count ranges from 150,000 cells/mm3 to 400,000 cells/mm3. A platelet count of 20,000 cells/mm3 places the client at severe risk for bleeding. All of the other values are within normal limits.
The nurse is caring for a client after a mastectomy. Which finding would indicate that the client is experiencing a complication related to the surgery? 1. Mild pain at the incisional site 2. Arm edema on the operative side 3. Sanguineous drainage in the drainage tube 4. Complaints of decreased sensation near the operative site
2 Arm edema on the operative side (lymphedema) is a complication after mastectomy that can occur immediately, months, or even years after surgery. Options 1, 3, and 4 are expected occurrences after mastectomy and are not indicative of a complication.
The nurse is reviewing the medical history of a client admitted to the hospital with a diagnosis of colorectal cancer. The nurse understands that which information documented in the medical history is an unassociated risk factor of this type of cancer? 1. Family history of colon cancer 2. Regular consumption of a high-fiber diet 3. A history of inflammatory bowel disease 4. Regular consumption of a diet high in fats and carbohydrates
2 Colorectal cancer most often occurs in populations with diets low in fiber and high in refined carbohydrates, fats, and meats. Other risk factors include a family history of the disease, rectal polyps, and active inflammatory disease of at least 10 years' duration.
The nurse is assisting in developing a plan of care for a client with acquired immunodeficiency syndrome (AIDS) who is experiencing night fever and night sweats. Which nursing intervention should the nurse suggest including in the plan of care to manage this symptom? 1. Administer a sedative at bedtime. 2. Administer an antipyretic at bedtime. 3. Keep the call bell within reach for the client. 4. Provide a back rub and comfort measures before bedtime.
2 For clients with AIDS who experience night fever and night sweats, it is useful to offer an antipyretic at bedtime. It is also helpful to keep a change of bed linens and night clothes nearby for use. The pillow should have a plastic cover, and a towel may be placed over the pillowcase if there is profuse diaphoresis. The client should have liquids at the bedside to drink. Options 1, 3, and 4 are important interventions but they are unrelated to the subject of fever and night sweats.
The nurse prepares to give a bath and change the bed linens on a client with cutaneous Kaposi's sarcoma lesions. The lesions are open and draining a scant amount of serous fluid. Which should the nurse incorporate in the plan during the bathing of this client? 1. Wearing gloves 2. Wearing a gown and gloves 3. Wearing a gown, gloves, and a mask 4. Wearing a gown and gloves to change the bed linens and gloves only for the bath
2 Gowns and gloves are required if the nurse anticipates contact with soiled items, such as wound drainage, or while caring for a client who is incontinent with diarrhea or a client who has an ileostomy or colostomy. Masks are not required unless droplet or airborne precautions are necessary. Regardless of the amount of wound drainage, a gown and gloves must be worn.
A nursing instructor asks a nursing student about the characteristics of Hodgkin's disease. The instructor determines that the student needs to read about the characteristics of this disease if the student states that which is an associated characteristic? 1. Presence of Reed-Sternberg cells 2. Occurs most often in older adults 3. Prognosis depends on the stage of the disease 4. Involvement of lymph nodes, spleen, and liver
2 Hodgkin's disease is a disorder of young adults and primarily occurs between the ages of 20 and 40. Options 1, 3, and 4 are characteristics of this disease.
The nurse is reviewing the laboratory results of a client with bladder cancer and bone metastasis and notes that the calcium level is 15 mg/dL. The nurse should take which appropriate action? 1. Document the findings. 2. Notify the health care provider. 3. Increase calcium-containing foods in the diet. 4. Ask the unit secretary to file the report in the client's record.
2 Hypercalcemia is a serum calcium ion level greater than 11 mg/dL or 5.5 mEq/L. It most often occurs in clients who have bone metastasis and is a late manifestation of extensive malignancy. The presence of cancer in the bone causes the bone to release calcium into the bloodstream. Hypercalcemia is an oncological emergency, and the health care provider must be notified.
The nurse is assisting in the care of a client diagnosed with multiple myeloma who has been prescribed an intravenous solution. Which finding would indicate a positive response to this treatment? 1. Weight increase of 1 kg 2. Creatinine of 1 mg/dL 3. Respirations of 18 breaths per minute 4. White blood cell count of 6000/mm3
2 In multiple myeloma, hydration is essential to prevent renal damage resulting from the Bence-Jones protein precipitating in the renal tubules and from excessive calcium and uric acid in the blood. Creatinine is the most accurate measure of renal status. The remaining options will not evaluate a response to this treatment.
A client calls the office of his primary care health care provider and tells the nurse that he was just stung by a bumblebee while gardening. The client is afraid of a severe reaction because his neighbor experienced such a reaction just 1 week ago. Which is the appropriate nursing action? 1. Advise the client to soak the site in hydrogen peroxide. 2. Ask the client if he ever sustained a bee sting in the past. 3. Tell the client to call an ambulance for transport to the emergency room. 4. Tell the client not to worry about the sting unless difficulty with breathing occurs.
2 In some types of allergies, a reaction occurs only on second and subsequent contacts with the allergen. Therefore, the appropriate action would be to ask the client if he ever received a bee sting in the past. Option 1 is not appropriate advice. Option 3 is unnecessary. The client should not be told "not to worry."
A complete blood cell count is performed on a client with systemic lupus erythematosus (SLE). The nurse should suspect that which finding will be reported from this blood test? 1. Increased neutrophils 2. Decrease of all cell types 3. Increased red blood cell count 4. Increased white blood cell count
2 In the client with SLE, a complete blood count commonly shows pancytopenia, a decrease of all cell types, probably caused by a direct attack of all blood cells or bone marrow by immune complexes. The other options are incorrect.
A client is tentatively diagnosed with ovarian cancer. The nurse gathers data about which late symptom of this disease? 1. Mild digestive complaints 2. Pelvic pain, anemia, and ascites 3. Normal bowel and bladder function 4. Vague lower abdominal discomfort
2 Pelvic pain, anemia, and ascites are experienced late in the disease process for ovarian cancer. Vague lower abdominal discomfort and mild digestive complaints are early symptoms. Bowel and bladder functions are also affected early in this type of cancer.
The nurse is assisting in preparing a plan of care for a client with acquired immunodeficiency syndrome (AIDS) who has nausea. Which dietary measure should the nurse include in the plan? 1. Red meat daily 2. Foods that are at room temperature 3. Dairy products with each snack and meal 4. Adding spices to food to make the taste more palatable
2 The client with AIDS experiencing nausea should avoid fatty products, such as dairy products and red meat. Meals should be small and frequent to lessen the chance of vomiting. Spices and odorous foods should be avoided because they aggravate nausea. Foods are best tolerated either cold or at room temperature.
A clinic nurse periodically cares for a client diagnosed with acquired immunodeficiency syndrome. The nurse assesses for an early manifestation of Pneumocystis jiroveci infection by monitoring for which sign/symptom at each client visit? 1. Fever 2. Cough 3. Dyspnea at rest 4. Dyspnea on exertion
2 The client with P. jiroveci infection usually has a cough as the first symptom, which begins as nonproductive and then progresses to productive. Later signs include fever, dyspnea on exertion, and finally dyspnea at rest.
The client is diagnosed with stage I of Lyme disease. The nurse should check the client for which characteristic of this stage? 1. Arthralgias 2. Flu-like symptoms 3. Enlarged and inflamed joints 4. Signs of neurological disorders
2 The hallmark of stage I is the development of a skin rash within 2 to 30 days of infection, generally at the site of the tick bite. The rash develops into a concentric ring, giving it a bull's-eye appearance. The lesion enlarges up to 50 to 60 cm, and smaller lesions develop farther away from the original tick bite. In stage I, most infected persons develop flu-like symptoms that last 7 to 10 days; these symptoms may reoccur later. Arthralgias and joint enlargements are most likely to occur in stage III. Neurological deficits occur in stage II.
The nurse is collecting data from a client with a history of bladder cancer. Which sign/symptom is the client most likely to report? 1. Dysuria 2. Hematuria 3. Urgency of urination 4. Frequency of urination
2 The most common symptom among clients with cancer of the bladder is hematuria. The client may also experience irritative voiding symptoms such as frequency, urgency, and dysuria; these symptoms are often associated with cancer in situ.
The nurse is reinforcing instructions to a client on performing a testicular self-examination (TSE). Which instruction should the nurse provide to the client? 1. Examine the testicles while lying down. 2. The best time for the examination is after a shower. 3. Gently touch the testicle with one finger to feel for a growth. 4. Testicular examinations should be done at least every 6 months.
2 The testicular self-examination is recommended after a warm bath or shower when the scrotal skin is relaxed. The client should stand to examine the testicles. Using both hands, with the fingers under the scrotum and the thumbs on top, the client should gently roll the testicles, feeling for any lumps. The testicular self-examination should be performed monthly.
The home care nurse is collecting data from a client who has been diagnosed with an allergy to latex. In determining the client's risk factors associated with the allergy, the nurse questions the client about an allergy to which food items? Select all that apply. 1. Eggs 2. Kiwi 3. Milk 4. Yogurt 5. Bananas
2, 5 Individuals who are allergic to kiwis, bananas, pineapples, tropical fruits, grapes, avocados, potatoes, hazelnuts, and water chestnuts are at risk for developing a latex allergy. This is thought to be due to a possible cross-reaction between the food and the latex allergen. The incorrect options are unrelated to latex allergy.
Which findings should cause the nurse to postpone administration of an immunization and do further data collection? Select all that apply. 1. Over 60 years of age 2. Immune deficiency disease 3. Axillary temperature of 99° F 4. Negative tuberculin skin test at 48 hours 5. Type 1 diabetes mellitus requiring insulin 6. Familial history of severe allergic responseto the immunization
2,6 Immune deficiency disease or immunosuppressive therapy require postponement of vaccination and checking with primary medical provider. Allergic responses to substances by the client or family members should be investigated. Being over 60 years of age is not a reason to postpone or cancel immunization. Axillary temperature of 99 is not febrile. A negative tuberculin skin test for tuberculosis is expected and normal. Having insulin-dependent diabetes mellitus places a person at risk for some conditions such as pneumonia and influenza, making immunizations more important.
The nurse determines that a client with which history is most at risk for endometrial cancer? 1. Surgical interventions 2. Steroid replacement therapy 3. Estrogen replacement therapy 4. Occupational exposure to dust
3 Endometrial cancer is related to the hormone estrogen because estrogen is the primary stimulant of endometrial proliferation. Steroid replacement therapy, occupational exposure to dust, and surgical interventions are not considered to be risk factors for endometrial cancer.
A gastrectomy is performed on a client with gastric cancer. In the immediate postoperative period the nurse notes bloody drainage from the nasogastric (NG) tube. Which action should the nurse take? 1. Irrigate the NG tube. 2. Measure abdominal girth. 3. Continue to monitor the drainage. 4. Ask the registered nurse to notify the health care provider (HCP) immediately.
3 Following gastrectomy, drainage from the NG tube is normally bloody for 24 hours postoperatively and then changes to brown-tinged, then to yellow or clear. Because bloody drainage is expected in the immediate postoperative period, the nurse should continue to monitor the drainage. There is no need to notify the HCP at this time. Measuring abdominal girth is performed to detect the development of distention. Following gastrectomy, an NG tube should not be irrigated.
The nurse is providing instructions to a client with acquired immunodeficiency syndrome (AIDS) who is experiencing night fever and night sweats. The nurse advises the client to do which action to increase comfort while minimizing symptoms? 1. Reduce fluid intake before bedtime. 2. Remove the plastic cover on the pillow. 3. Keep liquids on the nightstand at home. 4. Take an antipyretic after the fever spikes.
3 For clients with AIDS who experience night fever and night sweats, it is useful to keep liquids on the nightstand at home. The client should keep a plastic cover on the pillow and place a towel over the pillowcase if needed also. The client should not decrease fluid intake, and the client should take an antipyretic before going to sleep and before the fever spikes.
The nurse discusses the risk factors associated with gastric cancer as part of a health promotion program. The nurse determines that there is a need for further teaching if a member attending the program states that which factor is a risk? 1. History of gastric polyps 2. History of pernicious anemia 3. High meat and carbohydrate consumption 4. A diet of smoked, highly salted, and spicy food
3 High meat and carbohydrate consumption plays a role in the development of cancer of the pancreas, not gastric cancer. Options 1, 2, and 4 identify risk factors related to gastric cancer. The risk also is increased for males 50 years of age and older and clients with a history of precancerous lesions or chronic gastritis.
The nurse is reviewing the laboratory results of a client with leukemia who has received a regimen of chemotherapy. Which laboratory finding would provide information about the massive cell destruction that occurs with the chemotherapy? 1. Anemia 2. Decreased platelets 3. Increased uric acid level 4. Decreased leukocyte count
3 Hyperuricemia is especially common after treatment for leukemias and lymphomas, because the therapy results in massive cell destruction, resulting in the release of uric acid. Although options 1, 2, and 4 may also be noted, an increased uric acid level is specifically related to cell destruction.
The nurse is assisting with developing a plan of care for a client who is experiencing hematological toxicity as a result of chemotherapy. The nurse should suggest including which in the plan of care? 1. Restricting all visitors 2. Restricting fluid intake 3. Restricting fresh fruits and vegetables in the diet 4. Inserting an indwelling urinary catheter to prevent skin breakdown
3 In a client who is experiencing hematological toxicity, a low-bacteria diet is implemented. This includes avoiding fresh fruits and vegetables and performing a thorough cooking of all foods. Not all visitors are restricted, but the client is protected from people with known infections. Fluids should be encouraged. Invasive measures such as an indwelling urinary catheter should be avoided to prevent infections.
The client is receiving external radiation to the neck for cancer of the larynx. The nurse monitors the client knowing that which is the most likely side/adverse effect of the external radiation? 1. Dyspnea 2. Diarrhea 3. Sore throat 4. Constipation
3 In general, only the area in the treatment field is affected by the radiation. Skin reactions, fatigue, nausea, and anorexia may occur with radiation to any site, whereas other side/adverse effects occur only when specific areas are involved in treatment. A client who is receiving radiation to the larynx is most likely to experience a sore throat. Options 2 and 4 may occur with radiation to the gastrointestinal (GI) tract. Dyspnea may occur with lung involvement.
The nurse is assisting in caring for a client receiving chemotherapy. On review of the morning laboratory results, the nurse notes that the white blood cell count is extremely low, and the client is immediately placed on neutropenic precautions. The client's breakfast tray arrives, and the nurse inspects the meal and prepares to bring the tray into the client's room. Which action should the nurse take before bringing the meal to the client? 1. Remove the coffee from the breakfast tray. 2. Ask the client if she feels like eating at this time. 3. Remove the fresh orange from the breakfast tray. 4. Call the dietary department and ask for disposable utensils.
3 In the immunocompromised client, a low-bacteria diet is implemented. This includes avoiding fresh fruits and vegetables and implementing thorough cooking of all foods. Removing the coffee from the tray is not necessary. Disposable utensils are used for clients who are infectious and present a risk of transmitting an infection to others. It is best to encourage the client to eat because nutrition is very important in a client receiving chemotherapy who is immunocompromised.
The client with acquired immunodeficiency syndrome is diagnosed with cutaneous Kaposi's sarcoma. Based on this diagnosis, the nurse understands that this has been confirmed by which? 1. Swelling in the genital area 2. Swelling in the lower extremities 3. Punch biopsy of the cutaneous lesions 4. Appearance of reddish-blue lesions on the skin
3 Kaposi's sarcoma lesions begin as red, dark blue, or purple macules on the lower legs that change into plaques. These large plaques ulcerate or open and drain. The lesions spread by metastasis through the upper body and then to the face and oral mucosa. They can move to the lymphatic system, lungs, and gastrointestinal tract. Late disease results in swelling and pain in the lower extremities, penis, scrotum, or face. Diagnosis is made by punch biopsy of cutaneous lesions and biopsy of pulmonary and gastrointestinal lesions.
The nurse is reinforcing discharge instructions to a client with cancer of the prostate after a prostatectomy. The nurse should reinforce which discharge instruction? 1. Avoid driving a car for 1 week. 2. Restrict fluid intake to prevent incontinence. 3. Avoid lifting objects heavier than 20 pounds for at least 6 weeks. 4. Notify the health care provider if small blood clots are noticed during urination.
3 Option 3 is an accurate discharge instruction after prostatectomy. Driving a car and sitting for long periods of time are restricted for at least 3 weeks. A daily fluid intake of 2 to 2.5 L/day should be maintained to limit clot formation and prevent infection. Small pieces of tissue or blood clots can be passed during urination for up to 2 weeks after surgery.
A client with acquired immunodeficiency syndrome (AIDS) is experiencing shortness of breath related to Pneumocystis jiroveci pneumonia. Which measure should the nurse suggest to assist the client in performing activities of daily living? 1. Offer low microbial food. 2. Provide small, frequent meals. 3. Provide supportive care with hygiene needs. 4. Provide meals and snacks with high protein, high calorie, and high nutritional value.
3 Providing supportive care with hygiene needs as needed reduces the client's physical and emotional energy demands and conserves energy resources for other functions such as breathing. Options 1, 2, and 4 are important interventions for the client with AIDS but do not address the subject of activities of daily living. Option 1 will decrease the client's risk of infection. Option 2 will assist the client in tolerating meals better. Option 4 will assist the client in maintaining appropriate weight and proper nutrition.
The nurse is reviewing the record of a client with a diagnosis of cervical cancer. Which should the nurse expect to note in the client's record related to a risk factor associated with this type of cancer? 1. Single female, no children 2. Intercourse with a single partner 3. History of human papillomavirus 4. Intercourse with circumcised males
3 Risk factors associated with cervical cancer include intercourse with uncircumcised males, early frequent intercourse with multiple sexual partners, multiparity, chronic cervicitis, and history of genital herpes or human papillomavirus infection. Incidence of cervical cancer is also higher in blacks.
The nurse is assigned to care for a client admitted to the hospital with a diagnosis of systemic lupus erythematosus (SLE). The nurse reviews the health care provider's prescriptions. Which medication does the nurse expect to be prescribed? 1. Antibiotic 2. Antidiarrheal 3. Corticosteroid 4. Opioid analgesic
3 Treatment of systemic lupus erythematosus is based on the systems involved and symptoms. Treatment normally consists of anti-inflammatory drugs, corticosteroids, and immunosuppressants. The incorrect options are not standard components of medication therapy for this disorder.
The nurse is assisting in caring for a client with an inoperable lung tumor and helps develop a plan of care by addressing complications related to the disorder. The nurse includes monitoring for the early signs of vena cava syndrome in the plan. Which early sign of this oncological emergency should the nurse include monitoring for in the plan of care? 1. Disorientation 2. Hand and arm edema 3. Edema of the face and eyes 4. Bluish skin discoloration around the mouth
3 Vena cava syndrome occurs when the superior vena cava is compressed or obstructed by tumor growth. Early signs and symptoms generally occur in the morning and include edema of the face, especially around the eyes, and client complaints of tightness of a shirt or blouse collar. As the compression worsens, the client experiences edema of the hands and arms. Mental status changes and cyanosis are late signs.
A female client arrives at the health care clinic and tells the nurse that she was just bitten by a tick and would like to be tested for Lyme disease. The client tells the nurse that she removed the tick and flushed it down the toilet. Which nursing action is appropriate? 1. Refer the client for a blood test immediately. 2. Inform the client that there is not a test available for Lyme disease. 3. Tell the client that testing is not necessary unless arthralgia develops. 4. Instruct the client to return in 4 to 6 weeks to be tested, because testing before this time is not reliable
4 A blood test is available to detect Lyme disease; however, the test is not reliable if performed before 4 to 6 weeks following the tick bite. Antibody formation takes place in the following manner: immunoglobulin M is detected 3 to 4 weeks after Lyme disease onset, peaks at 6 to 8 weeks, and then gradually disappears; immunoglobulin G is detected 2 to 3 months after infection and may remain elevated for years. Options 1, 2, and 3 are incorrect.
The nurse is reviewing the laboratory results of a client who is receiving chemotherapy and notes that the platelet count is 10,000 cells/mm3. On the basis of this laboratory value, the nurse should collect which data as a priority? 1. Temperature 2. Lung sounds 3. Status of skin turgor 4. Level of consciousness
4 A high risk of hemorrhage exists when the platelet count drops below 20,000/mm3. Fatal central nervous system hemorrhage or massive gastrointestinal hemorrhage can occur when the platelet count is less than 10,000 cells/mm3. The client should be monitored for changes in the level of consciousness, which may be an early indication of an intracranial hemorrhage. Option 2 is a priority when the white blood cell count is low and the client is at risk for an infection. Although options 1 and 3 are important, they are not the priority in this situation.
The client is hospitalized for the insertion of an internal cervical radiation implant. While giving care, the nurse finds the radiation implant in the bed. Which is the immediate nursing action? 1. Call the health care provider (HCP). 2. Reinsert the implant into the vagina. 3. Pick up the implant with gloved hands and flush it down the toilet. 4. Pick up the implant with long-handled forceps and place into a lead container.
4 A lead container and long-handled forceps should be kept in the client's room at all times during internal radiation therapy. If the implant becomes dislodged, the nurse should pick up the implant with long-handled forceps and place it into the lead container. Options 2 and 3 are inaccurate interventions. It is not within the realm of nursing responsibilities to insert a radiation implant. Option 3 exposes the nurse and possibly others to the radiation. Although the HCP needs to be notified, this is not the immediate action.
A client reports to the health care clinic to obtain testing regarding human immunodeficiency virus (HIV) status after being exposed to an individual who is HIV positive. The test results are reported as negative and the client tells the nurse that he feels so much better knowing that he has not contracted HIV. The nurse explains the test results to the client, providing which information? 1. There is no further need for testing. 2. The test should be repeated in 1 week. 3. A negative HIV test is considered accurate. 4. A negative HIV test is not considered accurate during the first 6 months after exposure.
4 A test done for HIV should be repeated. There might be a lag period after the infection occurs and before antibodies appear in the blood. Therefore, a negative HIV test is not considered accurate during the first 6 months after exposure
The nurse is assisting in administering immunizations at a health care clinic. The nurse understands that immunization provides which? 1. Protection from all diseases 2. Innate immunity from disease 3. Natural immunity from disease 4. Acquired immunity from disease
4 Acquired immunity can occur by receiving an immunization that causes antibodies to a specific pathogen to form. Natural (innate) immunity is present at birth. No immunization protects the client from all diseases.
A client with endometrial cancer is receiving doxorubicin (Adriamycin), an antineoplastic agent. The nurse should specifically collect data about which criterion? 1. Level of orientation 2. Neuromuscular reflexes 3. Pupillary response to light 4. Hematological laboratory values
4 Because of bone marrow suppression during therapy with antineoplastic agents, hematological laboratory values should be monitored closely. The incorrect options reflect neurological symptoms, which are not the concern with this medication.
A client with cancer develops white, doughy patches on the mucous membranes of the oral cavity. Which action should the nurse take when noting this? 1. Do nothing because this is a normal finding. 2. Encourage the client to use better oral hygiene. 3. Check the client's most recent electrolyte results. 4. Report these symptoms, which are consistent with candidiasis.
4 Candidiasis is an infection caused by the fungus Candida albicans. It appears as white plaques on the corners of the mouth with an underlying red base and fissures. It is not a common infection, although it can occur in an immunocompromised client. The client requires treatment with an antifungal agent to eliminate the infection. The finding has nothing to do with electrolyte imbalance.
When reviewing the health care record of a client with ovarian cancer, the nurse recognizes which sign/symptom as being a typical manifestation of the disease? 1. Diarrhea 2. Hypermenorrhea 3. Abnormal bleeding 4. Abdominal distention
4 Clinical manifestations of ovarian cancer include abdominal distention, urinary frequency and urgency, and abdominal pain, caused by pressure from the growing tumor, resulting in urinary or bowel obstruction, and constipation. Abnormal bleeding is associated with uterine cancer and often results in hypermenorrhea.
The home care nurse is prescribing dressing supplies for a client who has an allergy to latex. The nurse asks the medical supply personnel to deliver which? 1. Elastic bandages 2. Adhesive bandages 3. Brown Ace bandages 4. Cotton pads and silk tape
4 Cotton pads and plastic or silk tape are latex-free products. The items identified in the incorrect options are products that contain latex.
The nurse is reinforcing instructions to a group of adults about the seven warning signs of cancer. The nurse determines that a member of the group needs further teaching if the member states which sign/symptom is a warning sign? 1. Nagging cough or hoarseness 2. Change in bowel or bladder habits 3. Indigestion or difficulty swallowing 4. Absence or decreased frequency of menses
4 Each of the seven warning signs of cancer begins with a letter from the word CAUTION. The one that is not part of the seven is absence or decreased frequency of menses. This particular item could be indicative of pregnancy or menopause, as well as other pathological problems. Unusual bleeding or discharge, however, is one of the warning signs.
The nurse is collecting data from a client who is admitted to the hospital for diagnostic studies to rule out the presence of Hodgkin's disease. Which question should the nurse ask the client to elicit information specifically related to this disease? 1. "Are you tiring easily?" 2. "Do you have any weakness?" 3. "Have you gained any weight?" 4. "Have you noticed any swollen lymph nodes?"
4 Hodgkin's disease is a chronic progressive neoplastic disorder of lymphoid tissue characterized by the painless enlargement of lymph nodes with progression to extralymphatic sites, such as the spleen and liver. Weight loss is most likely to be noted. Fatigue and weakness may occur but are not significantly related to the disease.
The client is admitted to the hospital with a diagnosis of suspected Hodgkin's disease. Which finding should the nurse most likely expect to find documented in the client's record? 1. Fatigue 2. Weakness 3. Weight gain 4. Enlarged lymph nodes
4 Hodgkin's disease is a chronic, progressive neoplastic disorder of the lymphoid tissue that is characterized by the painless enlargement of the lymph nodes with progression to extralymphatic sites, such as the spleen and liver. Weight loss is more likely to be noted than weight gain. Fatigue and weakness may occur, but they are not significantly related to the disease.
Which individual is least at risk for the development of Kaposi's sarcoma? 1. A kidney transplant client 2. A male with a history of same-sex partners 3. A client receiving antineoplastic medications 4. An individual working in an environment where exposure to asbestos exists
4 Kaposi's sarcoma is a vascular malignancy that presents as a skin disorder and is a common acquired immunodeficiency syndrome indicator. It is seen frequently in men with a history of same-sex partners. Although the cause of Kaposi's sarcoma is not known, it is considered to be the result of an alteration or failure in the immune system. The renal transplant client and the client receiving antineoplastic medications are at risk for immunosuppression. Exposure to asbestos is not related to the development of Kaposi's sarcoma.
A client who has been diagnosed with multiple myeloma asks the nurse about the diagnosis. The nurse bases the response on which characteristic of the disorder? 1. Altered red blood cell production 2. Altered production of lymph nodes 3. Malignant exacerbation in the number of leukocytes 4. Malignant proliferation of plasma cells and tumors within the bone
4 Multiple myeloma is a neoplastic condition that is characterized by the abnormal malignant proliferation of plasma cells and the accumulation of mature plasma cells in the bone marrow. Altered red blood cell production and altered production of lymph nodes are not characteristics of multiple myeloma. Exacerbation in the number of leukocytes describes the leukemic process.
The nurse is preparing a client for an intravesical instillation of an alkylating chemotherapeutic agent into the bladder for the treatment of bladder cancer. The nurse provides instructions to the client regarding the procedure. Which client statement indicates an understanding of this procedure? 1. "I need to stay on bed rest after the procedure is completed." 2. "I will need to immediately urinate after the instillation is done." 3. "After the instillation is done, I will need to retain the fluid for 30 minutes." 4. "After the instillation is done, I will need to change position every 15 minutes from side to side."
4 Normally the medication is injected into the bladder through a urethral catheter, the catheter is clamped or removed, and the client is asked to retain the fluid for 2 hours. The client is to change position every 15 to 30 minutes from side to side, and from supine to prone, or to resume all activity immediately during this time period. The client then voids and is instructed to drink water to flush the bladder.
A client is receiving radiation therapy to the brain because of a diagnosis of a brain tumor. Which side/adverse effect does the nurse expect the client is likely to experience? 1. Diarrhea 2. Pneumonitis 3. Esophagitis 4. Nausea and vomiting
4 Radiation therapy to the brain can cause cerebral edema. Clients may also experience nausea and vomiting because of the effects of the radiation on the brain's chemoreceptor trigger zone. Because hair follicles are destroyed by radiation, clients receiving radiation to the head may also experience hair loss. Pneumonitis and esophagitis relate to radiation to the respiratory system and upper gastrointestinal tract. Diarrhea is related to radiation to the lower gastrointestinal tract.
The nurse is assigned to care for a client with systemic lupus erythematosus (SLE). The nurse plans care considering which factor regarding this diagnosis? 1. A local rash occurs as a result of allergy. 2. It is a disease caused by overexposure to sunlight. 3. A continuous release of histamine in the body causes the disease. 4. It is an inflammatory disease of collagen contained in connective tissue.
4 SLE is an inflammatory disease of collagen contained in connective tissue. Options 1, 2, and 3 are not associated with this disease.
The nurse is collecting data from a client suspected of having ovarian cancer. Which question should the nurse ask the client to elicit information specifically related to this disorder? 1. "Have you been having diarrhea?" 2. "Have you had any abnormal vaginal bleeding?" 3. "Are you having any excessive vaginal bleeding?" 4. "Does your abdomen feel as though it is swollen?"
4 Signs/symptoms of ovarian cancer include abdominal distention, urinary frequency and urgency, pleural effusion, malnutrition, pain from pressure caused by the growing tumor and the effects of urinary or bowel obstruction, and constipation. Ascites with dyspnea and ultimately general severe pain will occur as the disease progresses. Abnormal bleeding, often resulting in hypermenorrhea, is associated with uterine cancer.
A client is suspected of having systemic lupus erythematous. The nurse monitors the client, knowing that which is one of the initial characteristic signs/symptoms of systemic lupus erythematous? 1. Weight gain 2. Subnormal temperature 3. Elevated red blood cell count 4. Rash on the face across the nose and on the cheeks
4 Skin lesions or a rash on the face across the bridge of the nose and on the cheeks is an initial characteristic sign of systemic lupus erythematosus (SLE). Fever and weight loss may also occur. Anemia is most likely to occur later in SLE.
The nurse is reinforcing instructions to a group of female clients about breast self-examination (BSE). When should the nurse instruct the client to perform this examination? 1. At the onset of menstruation 2. Every month during ovulation 3. Weekly at the same time of day 4. One week after menstruation begins
4 The BSE should be performed monthly about 7 days after the menstrual period begins. It is not recommended to perform the examination weekly; at the onset of menstruation and during ovulation, hormonal changes occur that may alter breast tissue.
The nurse provides skin care instructions to the client who is receiving external radiation therapy. Which statement by the client indicates the need for further teaching? 1. "I will handle the area gently." 2. "I will wear loose-fitting clothing." 3. "I will avoid the use of deodorants." 4. "I will limit sun exposure to 1 hour daily."
4 The client needs to be instructed to avoid exposure to the sun because of the risk of burns, resulting in altered tissue integrity. Options 1, 2, and 3 are accurate measures for the care of a client who is receiving external radiation therapy.
The nurse is reinforcing instructions to the client who is about to begin external radiation therapy on how to maintain optimal skin integrity during therapy. The nurse determines that there is a need for further teaching if the client states that he will do which action? 1. Eat a high-protein diet. 2. Avoid exposure to sunlight. 3. Wash the skin with a mild soap and pat dry. 4. Apply tight dressings over the area to prevent bleeding.
4 The client should avoid pressure on the irritated area and should wear loose-fitting clothing. The client should be encouraged to eat a high-protein diet to have necessary nutrients available for tissue growth and replacement. Other common instructions are to avoid sunlight and to wash the skin with mild soap and pat dry.
The nurse is reinforcing instructions to a client receiving external radiation therapy. The nurse determines that the client needs further teaching if the client states an intention to take which action? 1. Eat a high-protein diet. 2. Avoid exposure to sunlight. 3. Wash the skin with a mild soap and pat it dry. 4. Apply pressure on the radiated area to prevent bleeding.
4 The client should avoid pressure on the radiated area and should wear loose-fitting clothing to prevent a disruption in the skin integrity. The remaining options are accurate instructions regarding radiation therapy. Protein assists in the healing process. Options 2 and 3 will assist in preventing skin disruption.
A client who is human immunodeficiency virus (HIV) positive has had a tuberculin skin test. The results show a 7-mm area of induration. How should the nurse interpret the test? 1. It is negative. 2. It is borderline. 3. It is uncertain. 4. It is positive.
4 The client with HIV is considered to have positive results on skin testing with an area of 5 mm of induration or greater. The client without tuberculin HIV is positive with induration greater than 10 or 15 mm if the client is at low risk. The client with HIV is immunosuppressed, making a smaller area of induration positive for this type of client. It is also possible for the client infected with HIV to have false-negative readings because of the immunosuppression factor.
The nurse is reviewing the record of a client admitted to the hospital for treatment of bladder cancer. Which risk factor related to this type of cancer should the nurse likely note in the client's record? 1. Female African American 2. Recorded age of 35 years 3. Occupation of computer analyzer 4. Drinks coffee and smokes cigarettes
4 The incidence of bladder cancer is three times greater in men than in women and affects the white population twice as often as African Americans. It most often occurs after the age of 40 years. Environmental health hazards have been attributed as causes. Cigarette smoking and drinking coffee are some factors associated with bladder cancer.
The nurse is assisting with conducting a health-promotion program at a local school. The nurse determines that there is a need for further teaching if a student identifies which as a risk factor associated with cancer? 1. Stress 2. Viral factors 3. Exposure to radiation 4. Low-fat and high-fiber diets
4 Viruses may be one of multiple agents that act to initiate carcinogenesis and that have been associated with several types of cancer. Increased stress has been associated with causing the growth and proliferation of cancer cells. Two forms of radiation, ultraviolet and ionizing, can lead to cancer. High-fiber diets may reduce the risk of colon cancer. A diet that is high in fat may increase the risk of the development of certain cancers.
The nurse is assisting in caring for a client with a diagnosis of bladder cancer who recently received chemotherapy. The nurse receives a telephone call from the laboratory who reports that the client's platelet count is 20,000/mm3. Based on this laboratory value, the nurse revises the plan of care and suggests including which intervention? 1. Return delivered fresh flowers to the florist. 2. Instruct the client not to eat any fresh fruits. 3. Monitor for signs of infection in the client. 4. Monitor skin for the presence of petechiae.
4 When the platelet count is decreased, the client is at risk for bleeding. A high risk of hemorrhage exists when the platelet count is less than 20,000/mm3. Fatal central nervous system hemorrhage or massive gastrointestinal hemorrhage can occur when the platelet count is less than 10,000/mm3. The client should be assessed for signs of bleeding. Options 1, 2, and 3 are specific interventions related to the risk of infection and although they may be a component of the plan of care, they are not specific to the risk for bleeding. Contact with fresh flowers is avoided when the client is at risk for infection and not necessarily when the client is at risk for bleeding. In addition, option 1 is not a therapeutically stated instruction to the client.