A female client with breast cancer is scheduled to receive a series of radiotherapy (RT). She has red hair, fair skin, and freckles. She tells the nurse that her skin is particularly sensitive to the sun, so she is worried that the radiation will adversely affect her skin. Which information should the nurse provide this client about RT? Select all that apply.

Rationale:

A. Clarify that all STIs are transmitted through sexual intercourse: Not all STIs are exclusively transmitted through intercourse; some can spread through oral-genital contact, skin-to-skin contact, or shared needles.

B. Emphasize that using safe sex practices removes the risk of STIs: Safe sex practices reduce the risk of STIs but do not completely eliminate it. Barrier methods like condoms lower transmission rates, but there is still a residual risk with skin-to-skin infections.

C. Explain that reinfections occur from sex with untreated partners: Clients treated for syphilis remain at risk of reinfection if their sexual partners are not also treated. Reinforcing this promotes partner notification and comprehensive treatment to stop the infection cycle.

D. Provide counseling that most contraceptives protect against infection: Most contraceptives, such as birth control pills, IUDs, or implants, prevent pregnancy but offer no protection against STIs. Only barrier methods like condoms can help prevent transmission.

Rationale for Correct Choices:

• Alcoholic cirrhosis: The client has a history of chronic heavy alcohol use, jaundice, RUQ tenderness, a distended abdomen, and abnormal liver ultrasound findings, all consistent with alcoholic cirrhosis. The presence of regenerative nodules and a nodular liver surface on imaging further supports this diagnosis.
• Aspartate aminotransferase (AST): The AST is elevated at 120 U/L (normal range: 10–40 U/L), which commonly occurs in alcoholic liver disease. In alcoholic cirrhosis, AST levels often exceed ALT and indicate ongoing hepatocellular injury.
• Ammonia: The client’s ammonia level is elevated at 90 mcg/dL (normal: 15–45 mcg/dL), suggesting impaired hepatic clearance and early signs of hepatic encephalopathy, both seen in advanced liver disease such as cirrhosis.

Rationale for Incorrect Choices:

• Acute pancreatitis: The client does not report severe epigastric pain radiating to the back, which is typical for pancreatitis. There is also no elevation of serum lipase or amylase, and imaging does not show pancreatic inflammation or edema.
• Hepatitis A: Hepatitis A usually presents with acute onset of symptoms like fever, malaise, and dark urine. It is typically short-term and not associated with the chronic liver changes (nodular liver, regenerative nodules) found in this client.
• Chloride: While slightly elevated, the chloride level is not specific to liver disease and has minimal diagnostic value in cirrhosis. It is not typically used as a marker for hepatic dysfunction or alcoholic liver disease.
• White blood cell count: The WBC count is elevated (16,000/mm³), but this can be attributed to various causes such as inflammation or infection. It does not specifically support the diagnosis of cirrhosis like AST and ammonia levels do.