Patient Profile:

• Name: Sarah Johnson
• Age: 54
• Diagnosis: Metastatic breast cancer, Stage IV, diagnosed six months ago with metastasis to the liver and bone

Treatment Plan:

• Surgery: Lumpectomy with axillary lymph node dissection
• Chemotherapy: Adriamycin and Cyclophosphamide (AC) regimen
• Radiation Therapy: Targeted treatment to the chest wall post-surgery

Clinical Presentation:

Subjective Data:

• Reports of nausea and vomiting, especially after chemotherapy sessions
• Expresses feelings of sadness and fear regarding her prognosis and the impact on her family
• States she has lost 10 pounds in the last month due to decreased appetite and nausea
• Describes pain in the surgical area and generalized body pain that worsens at night
• Mentions experiencing a red, itchy rash on her chest from radiation therapy

Objective Data:

• Vital signs: HR 78 bpm, BP 120/80 mmHg, Temp 98.6°F
• Weight: 135 lbs (down from 145 lbs)
• Physical examination reveals tenderness in the left breast and axilla

True or False: Emotional distress can decrease treatment adherence.

Choice A reason: Asking the patient to try bearing weight on the injured ankle is not appropriate at this stage. Bearing weight can cause further injury or exacerbate the swelling and pain. The initial treatment should focus on reducing swelling and providing support.

Choice B reason: Elevating the ankle above heart level is appropriate because it helps to reduce swelling by promoting venous return and decreasing fluid accumulation in the affected area. Elevation is a standard first aid measure for managing acute injuries and swelling.

Choice C reason: Applying a warm moist pack to the ankle is not advisable immediately after an injury. In the acute phase, cold therapy (ice) is recommended to reduce swelling and pain. Warm therapy is more appropriate during the recovery phase, once swelling has subsided.

Choice D reason: Assessing the ankle's passive range of motion (ROM) may be necessary later, but not immediately upon arrival. The priority is to manage pain and swelling first. ROM assessments can be painful and might worsen the injury if conducted too soon.

Choice A reason: A blood pressure of 128/76 mm Hg is within the target range for a patient with hypertension, indicating that the current therapy is effectively managing the condition. This reading is below the generally accepted threshold for hypertension, which is 140/90 mm Hg.

Choice B reason: A blood pressure of 148/78 mm Hg is above the target range for hypertension management. This reading suggests that the patient may need an adjustment in their therapy to better control their blood pressure and reduce the risk of cardiovascular complications.

Choice C reason: A blood pressure of 98/56 mm Hg is too low and may indicate hypotension, which can be a concern, especially if the patient experiences symptoms like dizziness or fainting. This reading suggests that the patient's therapy may need to be adjusted to avoid excessively lowering blood pressure.

Choice D reason: A blood pressure of 128/92 mm Hg shows an elevated diastolic pressure, which is above the target range. This indicates that the patient's hypertension is not fully controlled, and adjustments in therapy may be needed to bring both systolic and diastolic pressures within the desired range.