The practical nurse (PN) is completing a focused assessment of a client who was admitted yesterday with polycythemia vera. Which finding should the PN report to the charge nurse immediately?

Choice A reason: Providing reassurance that hair loss is not usually permanent offers the client some comfort during a challenging time. Informing her that the color and texture may change when it grows back prepares her for potential differences in her hair's appearance post-chemotherapy. This response acknowledges the temporary nature of chemotherapy-induced hair loss while also being honest about the possibility of changes, which helps manage the client's expectations effectively.
Choice B reason: Stating that "people with cancer react differently to chemotherapy" is true, but it is not the most supportive or informative response. It may leave the client feeling uncertain and anxious about the outcome. Providing more specific information about hair regrowth, as in choice A, is more helpful in addressing the client's concerns and providing reassurance.
Choice C reason: While acknowledging that wigs are available is practical, focusing on the possibility that hair might not grow back can be disheartening for the client. It is important to offer hope and positivity where possible, and emphasizing the usual pattern of hair regrowth, as in choice A, is a more supportive approach. If the client does have concerns about wigs, this can be discussed separately.
Choice D reason: Indicating that hair regrowth depends on the amount of drug received is somewhat accurate but lacks the reassurance and positivity provided in choice A. It is important to give the client a clearer understanding that, in most cases, hair loss from chemotherapy is temporary, and hair will generally grow back. This helps alleviate some of the stress associated with the treatment.

Choice A reason: Returning for a urine culture and imaging is an important part of follow-up care for a client with pyelonephritis. These tests can help ensure that the infection has been completely resolved and that there are no underlying structural abnormalities contributing to the condition. However, while follow-up appointments are crucial, the immediate priority for discharge instructions is to emphasize the importance of adhering to the prescribed medication regimen to ensure the effectiveness of the treatment.
Choice B reason: Using nonsteroidal anti-inflammatory drugs (NSAIDs) for pain can help manage discomfort associated with pyelonephritis. However, pain management is secondary to ensuring that the infection is effectively treated. While it is important to address the client's pain, reinforcing the need to follow the prescribed medication regimen takes precedence to ensure that the infection is adequately managed and prevented from worsening or recurring.
Choice C reason: Adhering strictly to the medication regimen is the most important instruction for the client. Ensuring that the client takes the full course of prescribed antibiotics is critical to effectively treating the pyelonephritis and preventing the development of antibiotic resistance or recurrent infections. Reinforcing the importance of completing the antibiotic course as directed helps ensure that the infection is fully eradicated and reduces the risk of complications.
Choice D reason: Ensuring effective perineal hygiene is important for preventing urinary tract infections (UTIs) and maintaining overall urinary health. While it is a relevant aspect of care, it is not the most critical instruction for the client at the point of discharge. The primary focus should be on the adherence to the medication regimen to treat the current infection and prevent further complications. Perineal hygiene practices can be reinforced as part of overall health education but are not the immediate priority compared to medication adherence.