A nurse is caring for a client who is receiving radiation therapy through a sealed implant. Which of the following actions should the nurse take?

Instruct visitors to stand 0.6 m (2 feet) away from the client.

Wear a lead apron when providing care for the client.

Remove all bed linens from the client's room each day.

Place a dosimeter film badge at the client's bedside.

Answer and Explanation

The Correct Answer is B

A. Instruct visitors to stand 0.6 m (2 feet) away from the client: While maintaining distance can reduce radiation exposure, standard precautions for sealed implants typically require visitors to be limited in time and distance, but the priority for staff is proper protective equipment rather than only instructing visitors.

B. Wear a lead apron when providing care for the client: Wearing a lead apron is essential for staff safety when caring for a client with a sealed radiation implant. The apron shields the nurse from radiation exposure, which is the primary protective measure during direct care.

C. Remove all bed linens from the client's room each day: Frequent removal of linens is unnecessary for sealed radiation implants because the radiation source is contained. Standard precautions for linen handling are sufficient unless the linens are visibly contaminated with bodily fluids.

D. Place a dosimeter film badge at the client's bedside: Dosimeter badges are worn by staff to monitor personal radiation exposure, not placed at the client’s bedside. Proper usage involves staff wearing the badge on their body while providing care.

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Correct Answer is C

Explanation

A. Type 1 diabetes mellitus: Type 1 diabetes is not directly linked to an increased risk of cervical cancer. While chronic illnesses can affect overall health, they are not specific risk factors for cervical neoplasia.

B. Hypertension: Hypertension is a cardiovascular condition and does not contribute to the development of cervical cancer. It is not considered a risk factor in gynecologic oncology.

C. History of STIs: A history of sexually transmitted infections, particularly human papillomavirus (HPV), is a major risk factor for cervical cancer. HPV infection can cause cellular changes in the cervix that may progress to malignancy if not detected and managed early.

D. Nulliparity: While nulliparity has been associated with a slightly increased risk in some cancers, it is not as significant a risk factor for cervical cancer as HPV or other STIs. The primary focus in cervical cancer risk assessment is exposure to HPV.

A. Monitor for abdominal ascites. B. Implement a low-carbohydrate diet. C. Review serum amylase levels. D. Place warm compresses on areas of pruritus

Correct Answer is A

Explanation

A. Monitor for abdominal ascites: Clients with cirrhosis are at risk for fluid accumulation in the peritoneal cavity due to portal hypertension and hypoalbuminemia. Monitoring abdominal girth, weight, and signs of fluid retention is essential for early detection and timely intervention to prevent complications such as respiratory compromise or infection.

B. Implement a low-carbohydrate diet: Cirrhosis does not typically require a low-carbohydrate diet; instead, clients often need adequate calories and protein to prevent malnutrition. Restricting carbohydrates unnecessarily can worsen energy deficits and muscle wasting.

C. Review serum amylase levels: Serum amylase is primarily used to assess pancreatic function, not liver function. Liver disease monitoring focuses on liver enzymes (AST, ALT), bilirubin, and coagulation studies rather than amylase levels.

D. Place warm compresses on areas of pruritus: Pruritus in cirrhosis is better managed with cool baths, moisturizing creams, or medications like cholestyramine. Warm compresses can exacerbate itching by increasing skin blood flow and should generally be avoided.

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