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Applying a warm compress is not appropriate as an initial intervention when a patient reports sudden severe burning during chemotherapy infusion. The priority is to stop the infusion immediately and assess the site. In addition, the use of warm versus cold compresses depends on the specific chemotherapeutic agent involved. Some vesicants require cold compresses to limit tissue spread, while others require warmth to promote drug dispersion. Applying any compress before stopping the infusion and assessing the site could delay critical intervention and worsen tissue injury.

Severe burning pain at the IV site during chemotherapy administration is abnormal and highly suggestive of infiltration or extravasation, particularly with vesicant or irritant drugs. Reassuring the patient and continuing to monitor without action can result in progressive tissue damage, necrosis, blistering, infection, and potential loss of limb function. Prompt recognition and intervention are essential to prevent permanent injury.

Increasing the infusion rate is dangerous and contraindicated. If infiltration or extravasation is occurring, a faster infusion would force more of the chemotherapeutic agent into the surrounding tissue, significantly worsening tissue injury and pain. This action directly contradicts safe chemotherapy administration practices and could lead to irreversible damage.

The Trendelenburg position is not recommended for patients with active GI bleeding. It does not reliably improve cerebral perfusion and may increase the risk of aspiration, especially in a patient with hematemesis. Elevating the legs slightly or keeping the patient supine is safer if positioning is needed while resuscitation is initiated.

Oral proton pump inhibitors are not appropriate in the acute setting for a patient with active hematemesis and hypotension. The patient is at high risk for aspiration, and oral medications may not be absorbed effectively during shock. IV PPIs may be administered later after hemodynamic stabilization, but they are not the immediate priority.

Providing ice chips is contraindicated in a patient with active upper GI bleeding and hypotension. The patient should be kept NPO in anticipation of possible endoscopy or surgery, and oral intake increases the risk of aspiration and does not address the life-threatening problem of volume loss.

Preparing the patient for an endoscopic examination is important for identifying and treating the bleeding source; however, it is not the initial priority in an unstable patient. Endoscopy requires that the patient be hemodynamically stabilized first, as hypotension increases the risk of complications during the procedure.

Inserting a nasogastric tube may help assess for ongoing upper GI bleeding, but it is not a priority intervention in a patient who is already showing clear signs of significant bleeding and instability. NG tube placement can also cause discomfort and does not address the life-threatening issue of volume loss.

Proton pump inhibitors help reduce gastric acid secretion and promote clot stability, but they do not act immediately to correct hypotension or tachycardia. PPIs are typically administered after initial stabilization and often via the IV route, making them a secondary intervention rather than the first priority.

Hypertension is not a direct complication of rheumatoid nodules. While rheumatoid arthritis is a systemic inflammatory disease that can increase cardiovascular risk over time, the presence of nodules themselves does not directly cause hypertension and is not the priority concern related to elbow and forearm nodules.

Hypoglycemia is not associated with rheumatoid nodules. Although some medications used to treat rheumatoid arthritis (such as corticosteroids) can affect blood glucose levels, they are more commonly linked to hyperglycemia, not hypoglycemia, and this complication is unrelated to nodule formation.

Rheumatoid nodules do not increase joint mobility. In fact, rheumatoid arthritis typically causes joint stiffness, deformity, and decreased range of motion. Nodules are firm, non-tender subcutaneous masses that occur over pressure points and do not enhance movement.

Recommending complete bed rest is contraindicated in patients with ankylosing spondylitis. Prolonged immobility can worsen spinal stiffness, postural deformities, and chest wall restriction, increasing the risk of respiratory complications such as atelectasis and pneumonia. Maintaining mobility is essential to preserve lung expansion and functional ability.

NSAIDs are a cornerstone of treatment for pain and inflammation in ankylosing spondylitis, but they do not directly address respiratory function. While important for symptom control, medication administration is a secondary priority compared to interventions that prevent potentially serious respiratory complications.

Applying heat packs to the lower back may help relieve muscle tension and pain, but it does not improve chest expansion or lung function. Heat therapy is a comfort measure and should not take precedence over interventions aimed at preserving respiratory capacity.

Subcutaneous nodules on the ulnar side of the arm are characteristic of rheumatoid arthritis, not systemic lupus erythematosus. Rheumatoid nodules typically occur over pressure points and are associated with long-standing, seropositive rheumatoid arthritis rather than SLE.

A grey-colored, non-purpuric papular rash is not typical of SLE. Cutaneous manifestations of SLE most commonly include the malar rash, discoid lesions, and photosensitive rashes rather than grey papular eruptions.

Pitting edema of the hands and fingers is not a classic early finding of SLE. While edema may occur secondary to renal involvement (lupus nephritis), it is more commonly seen in the lower extremities and is not a defining or expected primary assessment finding.

Lying down after eating does increase the risk of GERD symptoms. When a person lies flat, gravity no longer helps keep stomach contents in the stomach, making reflux more likely. Clients with GERD are advised to remain upright for at least 2–3 hours after meals and to elevate the head of the bed.

Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) can irritate the gastric and esophageal mucosa and may worsen GERD symptoms or increase the risk of gastrointestinal bleeding. Therefore, it is not advisable to take aspirin routinely if GERD is present unless specifically prescribed.

Mercury-containing foods, such as certain seafood, are not associated with GERD symptoms. Dietary triggers for GERD are related to acid production, LES relaxation, and mucosal irritation.

Urine specific gravity reflects the kidney’s ability to concentrate or dilute urine, which can be influenced by hydration status, diuretics, or fluid intake. While it provides information about urine concentration, it is not the most accurate or reliable indicator of overall renal function, especially in chronic or progressive kidney disease.

Blood urea nitrogen (BUN) is influenced by many nonrenal factors, including hydration status, protein intake, gastrointestinal bleeding, and liver function. Although BUN may rise with renal impairment, it is less specific for assessing kidney function compared to creatinine.

Serum sodium reflects fluid and electrolyte balance, not kidney filtration ability. Sodium levels may remain normal even in significant renal impairment, making it an unreliable indicator of renal function.

A hiatal hernia does not directly increase the risk of lung disease. While severe or chronic gastroesophageal reflux secondary to a hiatal hernia can lead to aspiration of gastric contents, which may cause cough, asthma-like symptoms, or recurrent pneumonia, these respiratory complications are secondary and occur only in a subset of patients. They are not the primary risk associated with a hiatal hernia and are less relevant for standard patient education.

There is no direct causal link between hiatal hernia and stomach cancer. Hiatal hernias involve the displacement of the stomach through the diaphragm, leading primarily to reflux symptoms. Although chronic GERD can contribute to Barrett’s esophagus, a precancerous condition of the esophagus, the hernia itself does not increase gastric malignancy risk. Emphasizing cancer risk could cause unnecessary anxiety.

Hiatal hernias are not associated with intestinal cancers. The concern lies within the upper GI tract, particularly the esophagus and stomach, rather than the intestines. Patient education should avoid misleading information that could cause confusion.

Dull pain in the left upper quadrant is not indicative of appendicitis. Appendicitis typically begins as periumbilical or generalized abdominal pain, which later localizes to the right lower quadrant (RLQ). Left-sided pain is more commonly associated with conditions such as diverticulitis, splenic issues, or renal colic.

Hyperactive bowel sounds are not a specific indicator of appendicitis. While bowel sounds can vary in appendicitis, patients often present with normal or decreased bowel sounds due to localized inflammation or early paralytic ileus. Hyperactive sounds are more typical in gastroenteritis or early obstruction.

Pain relief when the right leg is flexed is not characteristic of appendicitis. In fact, certain maneuvers, like the psoas sign (pain on passive extension of the right hip) or obturator sign (pain on internal rotation of the flexed right hip), may exacerbate RLQ pain, but flexing the leg to relieve pain is not a diagnostic feature.