CLN Modifications Quiz

When working with clients at risk of developing lymphedema or with mild/moderate well controlled lymphedema, the goals and objectives of the oncology-trained massage therapist, esthetician and nail technician include which of the following? Check all that apply.

not to trigger lymphedema

Correct Incorrect Correct answer

if lymphedema already exists not to exacerbate it

Correct Incorrect Correct answer

to assess and manage the clients lymphedema

Correct Incorrect Correct answer

to assess, treat and manage the clients lymphedema

Correct Incorrect Correct answer

Which of the following essential elements are included in the “what you need to know” segment?

how to open the door to the lymphatic system

Correct Incorrect Correct answer

pressure considerations

Correct Incorrect Correct answer

observe the Quadrant principle a-b-c

Correct Incorrect Correct answer

all of the above

Correct Incorrect Correct answer

For estheticians, during a traditional facial the modifications (time, heat, pressure, stroke direction) for clients at risk of or with mild/moderate well managed lymphedema apply equally to the cleanse and the massage portion of the facial.

Yes

Correct Incorrect Correct answer

No

Correct Incorrect Correct answer

It does not matter

Correct Incorrect Correct answer

“Proximal to distal” and “proximal then distal” means the same thing.

Yes

Correct Incorrect Correct answer

No

Correct Incorrect Correct answer

The part of your leg most proximal to your hip is your ankle.

Yes

Correct Incorrect Correct answer

No

Correct Incorrect Correct answer

The part of your arm most distal to your shoulder are your fingers.

Yes

Correct Incorrect Correct answer

No

Correct Incorrect Correct answer

In the context of massage and facial modifications specific to clients with or at risk of lymphedema, the term proximal is used in relation to the “safety zone”.

Yes

Correct Incorrect Correct answer

No

Correct Incorrect Correct answer

A Circle C stroke is a hands-on application that includes a pressure (working) phase and a pressure-free (float/reset) phase, with the pressure phase moving in the direction of and into the “safety zone”.

Yes

Correct Incorrect Correct answer

No

Correct Incorrect Correct answer

Lymphedema occurs as a result of an interruption that alters the flow of lymph through the lymphatic system and presents as an accumulation of ____________.

fluid in the tissues

Correct Incorrect Correct answer

protein-rich fluid in the tissues

Correct Incorrect Correct answer

Risk reduction practices for clients with or at risk for lymphedema include which of the following? There is more than one correct answer, select all that apply.

Massage and skin care treatment considerations apply to the affected quadrant

Correct Incorrect Correct answer

Work in the affected quadrant for a shorter time so as not to overwork the at risk area placing an unnecessary "demand" on the already compromised lymphatic system, and/or cause hyperemia

Correct Incorrect Correct answer

Any touch applications or product use that cause the skin in the affected quadrant to redden are way too "demanding"

Correct Incorrect Correct answer

Lymphedema risk lasts a lifetime, and so too should the massage, skin care and nail treatment modifications and risk reduction practices

Correct Incorrect Correct answer

Minimize heat such as use of steam, table warmers, hot stones and hand mitts in the affected quadrant

Correct Incorrect Correct answer

Modify use of pressure in the affected quadrant

Correct Incorrect Correct answer

Modify direction of strokes in the affected quadrant

Correct Incorrect Correct answer

Which of the following statements is true regarding the risk of lymphedema due to cancer treatment?

Once a person returns to robust exercise, they are no longer at risk

Correct Incorrect Correct answer

The risk of developing lymphedema ends two years after completion of treatment

Correct Incorrect Correct answer

If only 3 or less lymph nodes from the cervical, axillary or inguinal area were affected then there is no lymphedema risk

Correct Incorrect Correct answer

Once at risk of developing lymphedema, a person has a life time risk of developing the condition

Correct Incorrect Correct answer

The Cervical Chain stroke direction modification uses strokes going ___________ the neck.

Up

Correct Incorrect Correct answer

Down

Correct Incorrect Correct answer

Across

Correct Incorrect Correct answer

Cervical Chain stroke direction modifications are required for clients who have compromised lymph nodes in the ___________ region.

Upper quadrant(s)

Correct Incorrect Correct answer

Lower quadrant(s)

Correct Incorrect Correct answer

Head/neck

Correct Incorrect Correct answer

For a client with compromised cervical lymph nodes the Circle C cleanse/massage modifications on the pectorals/décolleté move toward the median/sagittal watershed.

Yes

Correct Incorrect Correct answer

No

Correct Incorrect Correct answer

It does not matter

Correct Incorrect Correct answer

For a client with bilaterally compromised axillary lymph nodes the Circle C cleanse/massage modifications on the pectorals/décolleté can move toward the median/sagittal watershed and also up across the clavicles into the H/N area.

Yes

Correct Incorrect Correct answer

No

Correct Incorrect Correct answer

It does not matter

Correct Incorrect Correct answer

A quadrant exit stroke is a stroke that (a) CROSSES a watershed border and (b) where the direction of the stroke moves from the at risk treated quadrant into an area of safety.

Yes

Correct Incorrect Correct answer

No

Correct Incorrect Correct answer

It does not matter

Correct Incorrect Correct answer

For Lucy, a client with compromised LUQ axillary lymph nodes, a quadrant exit stroke could include strokes moving across the pectorals/décolleté and crossing the median/sagittal watershed from left to right.

Yes

Correct Incorrect Correct answer

No

Correct Incorrect Correct answer

It does not matter

Correct Incorrect Correct answer

The upper horizontal watersheds are also referred to as the “clavicular watershed” (anterior) and the “spine of the scapular watershed” (posterior) because of where they are located.

True

Correct Incorrect Correct answer

False

Correct Incorrect Correct answer

A client finished treatment for malignant melanoma on his right upper arm two years ago. He had an axillary sentinel node biopsy with 5 lymph nodes tested, and does not have lymphedema. How would you proceed with his right arm massage?

Use gentle full-hand contact on right arm. Massage from the elbow toward the wrist and hand with all strokes going down the arm.

Correct Incorrect Correct answer

Start and end the arm massage with quadrant exit strokes. Use gentle full-hand lateral contact on the right arm. With all strokes going up the arm, massage the upper part of the arm first, then the middle, then the lower part of the arm and hand

Correct Incorrect Correct answer

Allow the right arm to hang off the table for better lymph drainage

Correct Incorrect Correct answer

Which of the following is part of the protocol when massaging someone at risk for upper quadrant lymphedema (UQ/LE risk)?

When massaging a limb at risk and after preparing the area with quadrant exit strokes, begin the stroke pattern in the proximal part of the limb

Correct Incorrect Correct answer

Massage in the compromised quadrant for a little longer than usual because they need extra work in that area

Correct Incorrect Correct answer

Use strokes that cause hyperemia in the lymphedema risk area because that will bring extra fluid to the area and that is a good thing

Correct Incorrect Correct answer

When massaging the face/neck or performing a facial cleanse/massage on the face/neck the therapist should stroke from the neck area down into the pectoralis / décolleté area

Correct Incorrect Correct answer

When massaging the back or doing a back facial move strokes from the mid back, across the watershed(s), and into the H/N or lower quadrants

Correct Incorrect Correct answer

Which of the following is part of the protocol when massaging someone at risk for lower quadrant lymphedema (LQ/LE risk)?

When massaging the back stroke from the rib cage down into the lower quadrants

Correct Incorrect Correct answer

When massaging a limb at risk, begin the stroke pattern in the distal part of the limb

Correct Incorrect Correct answer

Use strokes that cause hyperemia in the area

Correct Incorrect Correct answer

Stroke toward the compromised lymph nodes to help move fluid in that direction

Correct Incorrect Correct answer

None of the above

Correct Incorrect Correct answer

Seven years ago a client was treated for breast cancer in the right breast. She had a bilateral mastectomy with eleven axillary nodes removed from the right side (all of those lymph nodes tested negative for cancer) and is currently in remission. She plays tennis regularly and would like to get deep tissue massage for both arms due to soreness caused by her tennis game. How should her massage/facial be modified?

The client may receive a traditional massage/facial using a massage pressure suitable for the client and that she is comfortable with, except for her right arm where lymphedema risk adaptations are required

Correct Incorrect Correct answer

The client may receive a traditional massage/facial using a massage pressure suitable for the client and that she is comfortable with, except for the upper right quadrant where lymphedema risk adaptations are required

Correct Incorrect Correct answer

The client has been in remission for more than 7 years so a traditional massage/facial with any pressures, light to deep, everywhere, is fine

Correct Incorrect Correct answer

This client may only receive light to moderate massage pressure during her entire massage or facial because of previous lymph node removal

Correct Incorrect Correct answer

A client reports a history of cancer with radiation to the left axillary area. She has no known history of lymphedema. How should the therapist proceed with the left arm massage?

Provide lateral arm massage strokes in the direction of the heart starting with the upper part of the arm/shoulder, then the middle part of the arm, then the lower part of the arm and hand, ending with quadrant exit strokes crossing the upper horizontal quadrant border(s)

Correct Incorrect Correct answer

Start the arm massage with quadrant exit strokes crossing the upper horizontal quadrant border(s), thereafter, provide lateral arm massage strokes in the direction of the heart starting with the upper part of the arm/shoulder, then the middle part of the arm, then the lower part of the arm and hand, ending with quadrant exit strokes crossing the upper horizontal quadrant border(s)

Correct Incorrect Correct answer

Before starting the arm massage prepare the area with strokes on the pectoralis/décolleté area moving from the median/sagittal watershed toward the axilla

Correct Incorrect Correct answer

No adjustments are needed for this situation

Correct Incorrect Correct answer

If a client who has not been diagnosed with lymphedema but is at risk of developing lymphedema mentions that they are experiencing unfamiliar warmth, swelling, numbness, tingling, tenderness/pain or a feeling of heaviness within the treated quadrant (this includes the limb), then the esthetician or massage therapist should flag that as a strong cautionary and advise that the client speak with their healthcare provider about that as soon as possible.

Yes

Correct Incorrect Correct answer

No

Correct Incorrect Correct answer

Standard intake and consult questions for all new clients should include which of the following:

Have you ever had lymph nodes biopsied, or included in surgeries or radiation? If yes, then where?

Correct Incorrect Correct answer

Have you had any medical treatments that affected your lymph nodes? If yes, then where?

Correct Incorrect Correct answer

Standard intake and consult questions for all clients, every time you see them, should include: Do you have any areas that feel warm, tender or heavy, or that have tingling or numbness?

Yes

Correct Incorrect Correct answer

No

Correct Incorrect Correct answer

Quiz Summary

Information

Results

Results

Categories

1. Question

2. Question

3. Question

4. Question

5. Question

6. Question

7. Question

8. Question

9. Question

10. Question

11. Question

12. Question

13. Question

14. Question

15. Question

16. Question

17. Question

18. Question

19. Question

20. Question

21. Question

22. Question

23. Question

24. Question

25. Question

26. Question