A nurse is reviewing the laboratory report of a client's most recent Pap smear that indicates moderately abnormal cervical cells were present. Based on the description of the cells, which of the following changes of precancerous cell growth to the client's cervix should the nurse identify?

Choice A reason:
Squamous cell carcinoma typically presents as a rough, scaly, red patch, open sore, or raised growth with a central depression, often on sun-exposed areas of the body. While it can appear as a lesion that varies in color, it is not commonly associated with a nevus that has increased in size.

Choice B reason:
Malignant melanoma is associated with changes in preexisting nevi, such as an increase in size and variations in color. It often appears as a mole that changes in color, size, or feel and may have irregular edges. The description of the lesion provided by the client is characteristic of malignant melanoma, making this the correct diagnosis.

Choice C reason:
Kaposi's sarcoma is a cancer that forms in the lining of blood and lymph vessels and typically appears as patches of abnormal tissue on the skin or mucous membranes. These lesions are usually red or purple and look similar to bruises¹. They are not typically described as nevi that increase in size or lesions that vary in color.

Choice D reason:
Basal cell carcinoma often appears as a slightly transparent bump on the skin, though it can take other forms. It usually presents as a pearly white or pink bump on white skin, or a brown or black bump on darker skin, and is most often found on sun-exposed areas. It is not typically associated with a nevus that has increased in size or an irregularly shaped lesion that varies in color.

Choice A reason:

While explaining discharge instructions is an important part of patient education and ensuring safety after leaving the hospital, it is not the immediate priority. The nurse must first address any potential medical issues that could compromise the patient's health, such as circulation and nerve function in the affected limb.

Choice B reason:

Applying an ice pack to the casted leg can help reduce swelling and provide comfort to the client. This is often recommended for the first 24 to 72 hours after the cast is applied, especially if the cast is on a leg. However, this is secondary to assessing the neurovascular status of the limb.

Choice C reason:

Performing a neurovascular assessment is the priority action for the nurse. This assessment includes checking for sensation, warmth, capillary refill, pulses, and movement. It is crucial to identify any signs of compromised blood flow or nerve injury early to prevent further complications.

Choice D reason:

Providing reassurance to the client and parents is important for emotional support and can help alleviate anxiety. However, the nurse's immediate priority is to ensure the physical well-being of the client, which includes performing a neurovascular assessment to detect any urgent issues.