A nurse in a provider's office is caring for a client who has cancer and has started chemotherapy.

A nurse is caring for a client who has cancer and is undergoing chemotherapy. Which of the following findings indicates an improvement in the client's condition? (Select all that apply.)

Rationale:

A. A WBC of 2,000/mm³ indicates leukopenia, which increases the risk of infection. Serving cooked fruits instead of raw fruits reduces exposure to bacteria and pathogens, as cooking kills microorganisms. This is a key infection-prevention measure for immunocompromised clients.

B. Negative-pressure rooms are used for clients with airborne infections (e.g., tuberculosis) to contain pathogens, not to protect an immunocompromised client. For a client with neutropenia, a protective isolation or positive-pressure environment is preferred to reduce exposure to pathogens.

C. Using an incentive spirometer helps prevent atelectasis and pneumonia, which is generally beneficial, but it does not directly prevent infections caused by neutropenia. It is not the priority infection-control intervention for a client with a WBC of 2,000/mm³.

D. Any elevated temperature in a neutropenic client is a medical emergency and should be reported immediately, even if lower than 39.5°C, because infection can progress rapidly. Waiting for 4 hours or for a very high fever could delay critical intervention.

Rationale:

A. For women who menstruate, breast tissue changes throughout the menstrual cycle due to hormonal fluctuations. During the follicular phase (approximately one week after the start of menstruation), estrogen and progesterone levels are relatively low, causing the breasts to be less swollen, less tender, and less lumpy. Performing a breast self-exam at this time makes it easier to detect any abnormal masses or changes accurately and reduces discomfort during palpation. This timing is recommended by organizations such as the American Cancer Society.

B. Breast tissue is not uniform throughout the menstrual cycle. Random timing can result in palpating normal hormonal-related lumps or tenderness, leading to confusion, false alarms, or missed findings. Consistency in timing improves the reliability of self-exams.

C. On the first day of menstruation, breasts may be tender, swollen, or engorged due to fluid retention and hormonal shifts. This can make palpation uncomfortable and less accurate, increasing the likelihood of either missing a true abnormality or misidentifying normal tissue changes as a lump.

D. Two weeks before menstruation corresponds to the luteal phase, when progesterone peaks. This can lead to breast engorgement, nodularity, and tenderness, making lumps harder to distinguish from normal cyclic changes. Conducting a self-exam at this time is less reliable.