A nurse learns that which of the following is the single biggest risk factor for developing cancer?

Rationale for Choice A:
A shift to the left in the white blood cell (WBC) count indicates an increased presence of immature neutrophils, known as bands. This is a hallmark sign of infection, as the body is rapidly producing and releasing these cells to fight off invading pathogens.
Prompt notification of the primary health care provider is crucial to initiate timely antibiotic therapy, if indicated. Early intervention with appropriate antibiotics can effectively combat the infection, prevent its progression, and potentially avert serious complications.
Delaying antibiotic treatment can allow the infection to worsen, potentially leading to sepsis, septic shock, or other life- threatening conditions.
Rationale for Choice B:
While informing the client about the significance of a shift to the left is important for education and understanding, it does not address the immediate need for medical intervention.
The priority action is to involve the primary health care provider for prompt assessment and potential initiation of antibiotic therapy.
Rationale for Choice C:
Documenting findings and continuing to monitor the client's condition is essential for ongoing assessment and evaluation, but it does not constitute a proactive intervention to address the underlying infection.
Documentation alone does not initiate treatment, and monitoring without intervention risks allowing the infection to progress.
Rationale for Choice D:
Protective isolation is not routinely indicated for clients with a shift to the left in their WBC count unless there is a specific concern for transmission of a highly contagious infection.
The decision to implement protective isolation measures would be based on the client's overall clinical presentation and potential infectious risks, as determined by the primary health care provider.

Choice A rationale:
Prednisone:
Corticosteroid that suppresses the immune system: It's crucial to consult with the primary healthcare provider (PCP) because prednisone can impair wound healing and increase the risk of infection after surgery. The PCP may need to adjust the dosage or temporarily discontinue prednisone prior to surgery.
Potential for adrenal insufficiency: Abrupt cessation of prednisone can lead to adrenal insufficiency, a life-threatening condition. The PCP will provide guidance on how to taper the medication safely before surgery.
Interaction with anesthesia: Prednisone can interact with certain anesthetic agents, potentially increasing the risk of complications. The PCP and anesthesiologist will need to coordinate care to ensure safe medication management during surgery.
Choice B rationale:
Metoprolol:
Beta-blocker that lowers blood pressure and heart rate: While metoprolol is generally safe to continue before surgery, it's still essential to inform the PCP and anesthesiologist about its use. They will monitor heart rate and blood pressure closely during and after surgery, as metoprolol can interact with certain medications used during the procedure.
Choice C rationale:
Warfarin:
Blood thinner that prevents blood clots: Warfarin requires careful management around surgery due to its significant bleeding risk. The PCP will typically recommend holding warfarin for several days before surgery to allow for normalization of blood clotting. They may also bridge with a shorter-acting anticoagulant if necessary.
Potential for bleeding complications: If warfarin is not managed appropriately, it can lead to excessive bleeding during or after surgery. The PCP will closely monitor the patient's INR (international normalized ratio), a measure of blood clotting, to ensure it's within the safe range for surgery.
Choice D rationale:
Insulin:
Hormone that regulates blood sugar: Patients with diabetes who take insulin require careful blood sugar control around surgery to prevent complications. The PCP will provide specific instructions on how to adjust insulin doses before, during, and after surgery, as insulin needs often change due to the stress of surgery and the impact of anesthesia.
Risk of hypoglycemia and hyperglycemia: Both low blood sugar (hypoglycemia) and high blood sugar (hyperglycemia) can have serious consequences during and after surgery. The PCP will work with the patient to manage blood sugar levels and prevent these complications.
Choice E rationale:
Phenytoin:
Anticonvulsant medication that controls seizures: Phenytoin has a narrow therapeutic window, meaning that blood levels must be closely monitored to ensure efficacy and prevent toxicity. Surgery can affect phenytoin levels, so the PCP will likely recommend checking a blood level before surgery and adjusting the dose as needed.
Potential for drug interactions: Phenytoin interacts with many medications, including some commonly used during surgery. The PCP will need to review the patient's medication list carefully and make any necessary adjustments to prevent interactions.
Choice F rationale:
Omega-3 fatty acid:
Generally safe to continue before surgery: Omega-3 fatty acids are not known to have significant interactions with medications used during surgery or to pose risks for wound healing or bleeding. However, it's always best to inform the PCP about any supplements being taken.