A hospitalized client has the following blood lab values: WBC 3,000/ul, RBC 5.0 (X 106), platelets 300, 000, what would be a priority nursing intervention?

Correct Answer: A

Rationale: With a WBC count of 3,000/ul (indicating leukopenia or low white blood cell count), the priority nursing intervention should be preventing infection. Leukopenia puts the client at a higher risk of developing infections due to a compromised immune system. Nurses should focus on implementing strict infection control measures, such as hand hygiene, maintaining a sterile environment, and promoting vaccination compliance to reduce the risk of infection for the hospitalized client. This intervention is crucial for ensuring the client's safety and well-being during their hospital stay. Alleviating pain, controlling infection, and monitoring blood transfusion reactions are important aspects of care but in this scenario, preventing infection takes precedence due to the client's low WBC count.

Correct Answer: B

Rationale: Possible signs of breast cancer include nipple discharge (especially if it is bloody) and a breast nodule or lump that can be felt. It is important to note any changes in the breasts and report them to a healthcare provider for evaluation. Fever, breast changes during menstruation, and erythema of the breast are not typically associated with breast cancer. It is essential for women to perform regular breast self-exams and seek medical attention if they notice any unusual changes in their breast tissue.

Correct Answer: A

Rationale: Painless hematuria, which is the presence of blood in the urine without any associated pain, is an early indicator of bladder cancer. This symptom is often one of the first signs of this type of cancer and should be promptly evaluated by a healthcare provider. It is crucial not to ignore the presence of blood in the urine, as it can indicate various underlying conditions, including bladder cancer. While other symptoms like Nocturia (waking up at night to urinate), Occasional polyuria (increased urination), and Dysuria (painful urination) can also occur with bladder cancer, painless hematuria is a significant red flag for the disease.

Correct Answer: D

Rationale: The correct instruction for the client when removing secretions above the cuff of a tracheostomy tube is to exhale deeply as the nurse re-inflates the cuff. By having the client exhale deeply during cuff inflation, it helps to prevent aspiration of secretions or air into the lungs. This action also helps in securing an airtight seal around the tracheostomy tube before the normal breathing is resumed. It is crucial to promote the safety and prevent complications in clients with a tracheostomy tube, especially post partial laryngectomy.

Correct Answer: C

Rationale: The American Cancer Society recommends that women have a mammogram annually, starting at age 45, and then have the option to switch to every two years starting at age 55. This is based on evidence showing that regular mammograms can help detect breast cancer early when it is most treatable. Breast self-examinations are no longer recommended as a routine screening method due to studies showing they do not reduce mortality from breast cancer. Clinical breast exams conducted by a physician are also not recommended for routine screening in average-risk women, as they have not been shown to be effective in reducing breast cancer mortality. Normal receptor assay testing is not a screening test for breast cancer and is used to help determine the best treatment options for diagnosed breast cancer cases.