Oncology

The nurse is developing a plan of care for a client following a radical mastectomy and includes measures that will assist in preventing lymphedema of the affected arm. The nurse should include which action to prevent this complication?

Following mastectomy, the arm should be elevated above the level of the heart per health care provider's prescription. Simple arm exercises should be encouraged. No blood pressure readings, injections, IV lines, or blood draws should be performed on the affected arm. Cool compresses are not a suggested measure for lymphedema prevention.

A client with ovarian cancer is scheduled to receive chemotherapy with cisplatin. The nurse assisting in caring for the client reviews the plan of care, expecting to note which intervention?

The client should receive prehydration before and during the infusion of this medication to minimize the risk of renal damage. Fluids are not restricted. Encouraging adequate dietary intake is appropriate, but a high-protein or low-fat diet is not necessary.

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?

- back pain - painless testucular swelling - heavy sensation in the scrotum

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?

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 reinforcing client education regarding symptoms of testicular cancer. The nurse encourages the client to report which symptoms as being associated with testicular cancer?

A grainy mass palpated in a testicle and enlargement of the testes are symptoms of testicular cancer and should be reported.

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?

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(lung sounds) is a priority when the white blood cell count is low and the client is at risk for an infection. Although options 1 (temp) and 3(skin turgor) are important, they are not the priority in this situation.

The nurse should monitor for which laboratory result as indicating an adverse reaction in the client with endometrial cancer who is receiving chemotherapy?

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.

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?

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.

The nurse is assisting in planning care for a client with Hodgkin's disease who is neutropenic as a result of radiation and chemotherapy. Which actions would be included in the client's plan of care?

Clients who are undergoing radiation and chemotherapy are at increased risk of infection and should not be exposed to others with infections. Hand washing is the best means of preventing the spread of infection. Monitoring white blood cell counts will indicate the extent of neutropenia. High protein diets and electrolyte monitoring will not decrease the risk of infection.

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?

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 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?

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 determines that a client with which history is most at risk for endometrial cancer?

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.

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?

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 is assisting in developing a postoperative plan of care for a client following a mastectomy. Which interventions will be included in the plan of care?

Following mastectomy, the arm should be elevated above the level of the heart. Specific arm exercises should be encouraged. No blood pressure readings, injections, IV lines, or blood draws should be performed on the affected arm. Cold compresses are not used in the postoperative period because of their vasoconstrictive effects. The nurse would also assess the incision and flap for signs of infection during dressing changes and would monitor and measure drainage in the collection device.

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?

High meat and carbohydrate consumption plays a role in the development of cancer of the pancreas, not gastric cancer.

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?

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 caring for a client with cancer receiving chemotherapy who has developed stomatitis. The nurse plans to give mouth care by using oral care agents and devices that meet which additional criterion?

Interventions used to treat stomatitis are based on the varying degrees and severity of the disorder. The incorrect options do not focus on the individual needs of the client with this complication of cancer chemotherapy.

The nurse is reinforcing discharge instructions to a client with cancer of the prostate after a prostatectomy. The nurse should reinforce which discharge instruction?

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.

The nurse is preparing a client with a bowel tumor for surgery. The health care provider has informed the client that the surgery is palliative in the treatment of the tumor. Which rationale is the reason to perform this type of surgery?

Palliative surgery that can benefit the client with cancer and improve quality of life includes procedures that reduce pain, relieve airway obstructions, relieve obstruction in the gastrointestinal and urinary tracts, relieve pressure on the brain and spinal cord, and prevent hemorrhage. Options 2, 3, and 4 do not describe palliative surgery.

A client is tentatively diagnosed with ovarian cancer. The nurse gathers data about which late symptom of this disease?

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.

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?

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 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?

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 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?

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.

The nurse is caring for a client with metastatic lung cancer. The client was medicated 2 hours ago and now reports a new and sudden sharp pain in the back. The nurse appropriately interprets this finding as possibly indicating which complication?

Spinal cord compression should be suspected in a client with metastatic disease, particularly when a new and sudden onset of back pain occurs. Spinal cord compression causes back pain before neurological changes occur. Spinal cord compression is an oncological emergency and needs to be reported. There are no data in the question to support a low pain threshold. The remaining options are not appropriate interpretations of the new and sudden pain that developed.

The nurse is reinforcing instructions to a group of high school males in a health class about how to perform a testicular self-examination (TSE). The nurse should make which statement?

TSE is recommended monthly after a warm bath or shower when the scrotal skin is relaxed. It also could be done near the end of the shower. The client should be standing to examine the testicles. The client should use both hands, placing fingers under the scrotum and thumbs on top, and should gently roll the testicles, feeling for any lumps.

The nurse is collecting data from a client with a history of bladder cancer. Which sign/symptom is the client most likely to report?

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 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?

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.

A client is receiving chemotherapy that carries a risk of phototoxicity as an adverse effect. Which finding indicates that the client experienced this side effect?

Typical photosensitivity reactions involve a "sunburn" reaction of the skin. It is characterized by erythema and blister formation. Warts result from viruses, whereas ecchymoses and petechiae indicate bleeding.

A client who has been receiving radiation therapy for bladder cancer tells the nurse that it feels as if she is voiding through the vagina. The nurse interprets that the client may be experiencing which?

A vesicovaginal fistula is a genital fistula that occurs between the bladder and the vagina. The fistula is an abnormal opening between these two body parts, and if this occurs, the client may experience drainage of urine through the vagina. The client's complaint is not associated with options 1, 3, and 4.

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?

Hodgkin's disease is a disorder of young adults and primarily occurs between the ages of 20 and 40. -PRESENCE OF REED STERNBERG CELLS -PROGNOSIS DEPENDS ON THE STAGE OF THE DISEASE -INVOLVEMENT OF LYMPH NODES, SPLEEN, LIVER

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?

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.

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?

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 is caring for a client after a mastectomy. Which finding would indicate that the client is experiencing a complication related to the surgery?

Arm edema on the operative side (lymphedema) is a complication after mastectomy that can occur immediately, months, or even years after surgery. -mild pain at the incisional site -sanguineous drainage in the drainage tube -complaints of decreased sensation near the operative site

A client with endometrial cancer is receiving doxorubicin (Adriamycin), an antineoplastic agent. The nurse should specifically collect data about which criterion?

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.

The nurse when inspecting the stoma of a client following an ureterostomy 6 hours ago, notes that the stoma appears pale in color. Which interpretation does the nurse make based on this finding?

Following ureterostomy, the stoma should be red and moist. A pale stoma may indicate an inadequate vascular supply. A dry stoma may indicate body fluid deficit. Any sign of darkness or duskiness in the stoma may mean loss of vascular supply and must be corrected immediately or necrosis can occur.

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?

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.

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?

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.

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?

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 provides skin care instructions to the client who is receiving external radiation therapy. Which statement by the client indicates the need for further teaching?

The client needs to be instructed to avoid exposure to the sun because of the risk of burns, resulting in altered tissue integrity. -handle area gently -wear loose fitting clothing -avoid deodorants

The nurse is caring for a client with an internal radiation implant. The nurse should observe which principle?

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.

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?

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.

A client with cancer has undergone a total abdominal hysterectomy and has a Foley catheter in place. The nurse should expect to note which type of urinary drainage immediately following this surgery?

blood tinged

The client with carcinoma of the lung develops the syndrome of inappropriate antidiuretic hormone (SIADH) as a complication of the cancer. The nurse anticipates that which may be prescribed to treat this complication? Select all that apply.

Cancer is a common cause of SIADH. In clients with SIADH, excessive amounts of water are reabsorbed by the kidney and put into the systemic circulation. The increased water causes hyponatremia (decreased serum sodium levels) and some degree of fluid retention. SIADH is managed by treating the condition and its cause, and treatment usually includes fluid restriction, increased sodium intake, and a medication with a mechanism of action that is antagonistic to ADH. Sodium levels are monitored closely because hypernatremia can suddenly develop as a result of treatment. The immediate institution of appropriate cancer therapy (usually either radiation or chemotherapy) can cause tumor regression so that ADH synthesis and release processes return to normal.

A nursing student is assisting in caring for a client with a lung tumor; the client will be having a pneumonectomy. The nursing instructor reviews the postoperative plan of care developed by the student and suggests deleting which item from the plan?

Closed chest drainage usually is not used following pneumonectomy. The serous fluid that accumulates in the empty thoracic cavity eventually consolidates. The consolidation prevents shifts of the mediastinum, heart, and remaining lung. Complete lateral positioning is avoided because the mediastinum is no longer held in place on both sides by lung tissue and extreme turning may cause mediastinal shift and compression of the remaining lung. Options 2 and 3 are general postoperative measures.

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?

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 assisting in preparing a teaching plan of care for a client being discharged from the hospital following surgery for testicular cancer. Which instruction should the nurse suggest to include in the plan?

For the client who had testicular surgery, the nurse should emphasize the importance of notifying the health care provider if chills, fever, drainage, redness, or discharge occurs. These symptoms may indicate the presence of an infection. Often a prosthesis is inserted during surgery, so the client does not have to wait 6 months. The nurse instructs the client that he will be able to resume most of his usual activities within 1 week after discharge, except for lifting heavy objects (those weighing 20 pounds or more) and stair-climbing.

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?

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.

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?

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 with developing a plan of care for the client with multiple myeloma. Which is a priority nursing intervention for this client?

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 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?

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?

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 nurse has reinforced discharge instructions regarding home care to a client following a prostatectomy for cancer of the prostate. Which statement by the client indicates an understanding of the instructions?

The client needs to be instructed to avoid lifting objects heavier than 20 pounds for at least 6 weeks. Small pieces of tissue or blood clots can be passed during urination for up to 2 weeks after surgery and do not necessitate the need to notify the health care provider. Driving a car and sitting for long periods are restricted for at least 3 weeks. A high daily fluid intake of 2 to 2.5 L/day should be maintained to limit clot formation and prevent infection.

The health education nurse reinforces instructions to a group of clients regarding measures that will assist in preventing skin cancer. Which instructions should the nurse reinforce to the client?

The client should be instructed to avoid sun exposure between the hours of 10:00 am and 4:00 pm. Sunscreen, a hat, opaque clothing, and sunglasses should be worn for outdoor activities. The client should be instructed to examine the body monthly for the appearance of any possible cancerous or any precancerous lesions. Sunscreen should be reapplied every 2 to 3 hours and after swimming or sweating; otherwise, the duration of protection is reduced.

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?

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 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?

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.

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?

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.

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?

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 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?

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 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?

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.