# A client with newly diagnosed small cell lung cancer reports progressive facial swelling, distended neck and chest wall veins, and dyspnea worse when leaning forward. Which nursing action is the priority?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375011&lang=en  
> language: en  
> subject: NCLEX-RN  
> category: MOC

## Question

A client with newly diagnosed small cell lung cancer reports progressive facial swelling, distended neck and chest wall veins, and dyspnea worse when leaning forward. Which nursing action is the priority?

## Option

1. Place the client supine to facilitate jugular venous return
2. Elevate the head of the bed to 45 degrees and prepare for emergent airway management **✔ Correct answer**
3. Begin aggressive IV fluid resuscitation to dilute tumor markers
4. Apply tight compression stockings to redirect blood flow

**Correct answer: 2**

## Explanation

SVC syndrome from mediastinal mass causes obstruction of venous return with facial/upper-extremity swelling, distended chest-wall collaterals, and dyspnea. Stridor and orthopnea signal airway compromise — elevation of the head of bed reduces venous pressure and facilitates breathing. Emergent oncology and radiation oncology consult is required; treatment is radiation therapy, chemotherapy (especially small cell), or endovascular stenting. Supine positioning WORSENS venous engorgement. Aggressive fluids increase central venous pressure and edema. Compression stockings have no role in SVC obstruction.

## In-depth explanation

Pemberton sign: facial plethora and stridor with arms raised — bedside SVC syndrome maneuver. Small cell lung cancer is the most common cause.

## Clinical scenario

Stridor noted on auscultation. SpO2 92 percent on RA. Awake and oriented but anxious.

## Key concepts

- **SVC syndrome** — Obstruction of superior vena cava causing upper-body venous congestion.
- **Pemberton sign** — Facial plethora and dyspnea with arms elevated; suggests SVC obstruction.
- **endovascular stenting** — Catheter-placed metallic stent restoring SVC patency in malignant obstruction.

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