A client with cancer is receiving chemotherapy with a known vesicant. The client's IV has been in place for 72 hours. The nurse determines that a new IV site cannot be obtained, and leaves the present IV in place. Which is the greatest clinical risk related to this situation?

Peripheral neurovascular dysfunction.

Impaired skin integrity.

Fluid volume excess.

Acute pain and anxiety.

Answer and Explanation

The Correct Answer is B

A. Peripheral neurovascular dysfunction. While some chemotherapy agents can cause neuropathy, the immediate risk of a vesicant (a drug that can cause severe tissue damage if it leaks) is extravasation, leading to skin and tissue damage, rather than direct neurovascular impairment.
B. Impaired skin integrity. Vesicants can cause severe tissue necrosis if they extravasate (leak into surrounding tissues). Leaving an IV in place for 72 hours increases the risk of infiltration or extravasation, which can lead to serious complications, including blistering, necrosis, and deep tissue injury. Proper IV site rotation and monitoring are essential to prevent skin and tissue damage.
C. Fluid volume excess. Fluid volume excess is not a direct risk related to vesicant chemotherapy. While some IV fluids can contribute to fluid overload, the primary concern with vesicants is extravasation and tissue damage.
D. Acute pain and anxiety. While pain and anxiety can occur if extravasation happens, the greatest clinical risk is the physical damage caused by tissue necrosis. Pain is a symptom of extravasation, but preventing skin and tissue injury is the priority.

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Correct Answer is C

Explanation

A. A 70-year-old fair-skinned client who works as a secretary. While fair skin and older age increase skin cancer risk, indoor work minimizes UV exposure, which is the primary risk factor for skin cancer.
B. A 16-year-old dark-skinned client who tans in tanning beds once a week. Tanning bed use increases the risk of skin cancer, but darker skin has more melanin, which provides some UV protection. A fair-skinned person with prolonged outdoor exposure would be at higher risk.
C. A 65-year-old fair-skinned client who is a construction worker. This client has the highest risk due to chronic UV exposure from outdoor work, fair skin (which burns more easily), and older age (increased cumulative sun damage). Occupational sun exposure is a major risk factor for basal cell carcinoma, squamous cell carcinoma, and melanoma.
D. A 25-year-old dark-skinned client whose mother had skin cancer. Family history is a risk factor, but darker skin provides more UV protection. Additionally, younger age and less cumulative sun exposure make this client lower risk than an older, fair-skinned construction worker.

A. A 40-year-old client who smoked cigarettes as a teen. B. A 50-year-old woman with a maternal history of breast cancer. C. A woman who had a total hysterectomy 5 years ago for a grade 4 Pap smear. D. A man with no tumor marker elevation 3 years after prostate cancer treatment.

Correct Answer is B

Explanation

A. A 40-year-old client who smoked cigarettes as a teen. While smoking is a known risk factor for several cancers, a brief history of smoking in adolescence does not pose as high a risk as a strong family history of breast cancer. Long-term smoking exposure is more strongly linked to lung and other cancers.
B. A 50-year-old woman with a maternal history of breast cancer. A family history of breast cancer, especially in a first-degree relative (mother, sister, or daughter), significantly increases the risk of developing breast cancer. This client may also carry genetic mutations such as BRCA1 or BRCA2, further elevating the risk.
C. A woman who had a total hysterectomy 5 years ago for a grade 4 Pap smear. A grade 4 Pap smear indicates severe cervical dysplasia or carcinoma in situ, but a total hysterectomy removes the uterus and cervix, significantly reducing the risk of cervical cancer recurrence.
D. A man with no tumor marker elevation 3 years after prostate cancer treatment. This client is in remission with no current signs of active cancer. While prostate cancer survivors require monitoring, his risk is lower compared to someone with an active familial predisposition to cancer.

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A client with cancer is receiving chemotherapy with a known vesicant. The client's IV has been in place for 72 hours. The nurse determines that a new IV site cannot be obtained, and leaves the present IV in place. Which is the greatest clinical risk related to this situation?

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