A nurse is providing discharge teaching for a client who is postoperative following a simple mastectomy. The client is to begin outpatient radiation therapy the next day. Which of the following instructions about maintaining skin integrity should the nurse include?

Choice A: Vomiting is not the most serious side effect because it is a common and manageable side effect of chemotherapy. Vomiting is a reflex action that expels the contents of the stomach through the mouth. It can be caused by various factors such as nausea, motion sickness, or infection. It can also be caused by chemotherapy, which can irritate the lining of the stomach or trigger the vomiting center in the brain. Vomiting can be prevented or treated with antiemetic drugs, hydration, and dietary changes.

Choice B: Fatigue is not the most serious side effect because it is a common and manageable side effect of chemotherapy. Fatigue is a condition that causes extreme tiredness or exhaustion that is not relieved by rest or sleep. It can be caused by various factors such as anemia, inflammation, or pain. It can also be caused by chemotherapy, which can damage healthy cells and tissues and affect the body's energy production. Fatigue can be managed with exercise, nutrition, and stress reduction.

Choice C: Hair loss is not the most serious side effect because it is a common and temporary side effect of chemotherapy. Hair loss is a condition that causes hair to fall out from the scalp or other parts of the body. It can be caused by various factors such as genetics, hormones, or infection. It can also be caused by chemotherapy, which can target rapidly dividing cells such as hair follicles and prevent hair growth. Hair loss usually occurs within two to four weeks after starting chemotherapy and reverses within six months after stopping chemotherapy.

Choice D: Myelosuppression is the most serious side effect because it is a rare and life-threatening side effect of chemotherapy. Myelosuppression is a condition that causes a decrease in the production of blood cells in the bone marrow. It can lead to anemia (low red blood cells), neutropenia (low white blood cells), and thrombocytopenia (low platelets), which can cause symptoms such as weakness, infection, and bleeding. It can also be caused by chemotherapy, which can target rapidly dividing cells such as bone marrow cells and impair blood cell formation. Myelosuppression requires close monitoring and treatment with blood transfusions, growth factors, or antibiotics.

Choice A: Limit the intake of fluid. This action is not correct and should not be taught to the client. Limiting the intake of fluid can cause dehydration, urinary tract infection, or kidney stones. The client should drink enough fluid to keep her urine clear and odorless.

Choice B: Void every hour while awake. This action is not correct and should not be taught to the client. Voiding every hour while awake can cause bladder irritation, infection, or overdistension. The client should void when she feels the urge or at least every 3 to 4 hours.

Choice C: Perform Kegel exercises daily. This action is correct and should be taught to the client. Kegel exercises are exercises that strengthen the pelvic floor muscles that support the bladder and urethra. They can help improve bladder control and prevent urinary incontinence. The client should perform Kegel exercises daily by contracting and relaxing the muscles around the vagina and anus as if she is trying to stop urinating or passing gas.

Choice D: Take a laxative every night. This action is not correct and should not be taught to the client. Taking a laxative every night can cause diarrhea, dehydration, electrolyte imbalance, or dependence. The client should avoid constipation by eating a high-fiber diet, drinking plenty of fluids, and exercising regularly.