A client with chronic lymphocytic leukemia (CLL) had a stem cell transplant 45 days ago. Which of following findings most likely indicate graft versus host disease? (Select all that apply)

A. Slight bleeding from stoma when changing the appliance: Some slight bleeding can be normal when changing the appliance, especially if the stoma is new and there is irritation. However, persistent or heavy bleeding should be reported.

B. Urine output of 2 ml/hr: A urine output of 2 ml/hr is extremely low and should be investigated, but it is not immediately life-threatening. However, if the low output persists, it may indicate a problem such as dehydration, obstruction, or kidney issues.

C. Deep red, moist stoma: A deep red, moist stoma is a normal finding postoperatively. This is indicative of healthy tissue, as the stoma should be red and moist, similar to the inside of the mouth.

D. Musky, bluish stoma: A musky or bluish stoma is concerning as it can indicate inadequate blood flow (ischemia) to the stoma. This requires immediate attention because it could suggest that the stoma is not receiving adequate oxygen and nutrients, which may lead to necrosis and the need for surgical intervention.

A. Smoking: Smoking is a well-established risk factor for many cancers, including penile cancer. It weakens the immune system and damages DNA, increasing the risk of cancer development.

B. High dietary fiber intake: High dietary fiber intake is not a risk factor for penile cancer. In fact, a healthy diet rich in fiber can help lower the risk of various cancers, including colorectal cancer, but it is not linked to penile cancer.

C. History of genital warts: A history of genital warts, caused by certain strains of the human papillomavirus (HPV), is a significant risk factor for penile cancer. HPV infection can cause changes in penile cells that may lead to cancer.

D. Alcohol consumption: While excessive alcohol consumption is a risk factor for several cancers (e.g., head and neck, liver, esophageal), it is not consistently identified as a direct or strong independent risk factor for penile cancer

E. Age over 70 years: Older age is a significant risk factor for most cancers, including penile cancer. The incidence of penile cancer generally increases with advancing age, with the majority of cases occurring in men over 60 or 70 years old.

F. Exposure to sunlight: Exposure to sunlight is not a major risk factor for penile cancer. It is more relevant to skin cancers, particularly melanoma, but it does not directly affect the risk of penile cancer.

G. Human papillomavirus (HPV) infection: HPV infection is one of the most significant risk factors for penile cancer. Certain high-risk strains of HPV such as HPV-16 and HPV-18, are directly linked to the development of this cancer.