A client returns to the surgical unit following a right modified radical mastectomy with dissection of axillary lymph nodes. An appropriate nursing intervention in the postoperative care for the client includes:

changing the surgical dressing when it becomes saturated with drainage.

encouraging the client to obtain permanent breast prosthesis as soon as she is discharged from the hospital.

placing a limb alert bracelet on the right wrist as warning against blood pressure or venipunctures.

teaching the client to use the prescribed patient-controlled analgesia (PCA) every 20 mintues for the best pain relief.

Answer and Explanation

The Correct Answer is C

A.   While it's important to monitor the surgical dressing, changing it too frequently can increase the risk of infection and disrupt healing. Instead, nurses typically assess the dressing regularly and only change it if it's overly saturated or if ordered by a physician. It’s essential to follow specific protocols regarding dressing changes.
B.   A While breast prostheses can be an important part of post-mastectomy care for some clients, it is usually recommended that clients wait until they have fully healed and received counseling regarding their options. Immediate encouragement may be premature, as physical and emotional adjustments take time after surgery.
C.   This is an appropriate intervention. After axillary lymph node dissection, there is a risk of lymphedema in the affected arm. Placing a limb alert bracelet serves as a reminder to healthcare providers to avoid taking blood pressure or performing venipunctures on the affected arm, thus helping prevent complications.
D.   While PCA can be an effective method for managing postoperative pain, the timing and dosage should be based on the specific prescription and the client's individual needs. It’s crucial to educate the client about the PCA device and its use, but the specific interval may vary based on the medication's parameters and the patient's condition.

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Correct Answer is A

Explanation

A. Asking yes or no questions can help facilitate communication, as they require less verbal output from the client and can help the nurse understand the client’s needs or thoughts without overwhelming them
B. This option is somewhat useful, as practicing words can help the client regain some verbal skills. However, it may not be the most effective immediate intervention. Clients with expressive aphasia often struggle to produce speech rather than understand it, and they may not benefit as much from this approach without additional support from speech therapy.
C. This intervention is not beneficial for improving communication. Tracking time spent speaking could create additional pressure on the client and may contribute to frustration rather than facilitate communication. It does not address the underlying issue of expressive aphasia.
D. This is not an appropriate intervention. Changing the subject can confuse or frustrate the client further, making it more difficult for them to communicate. It does not support their efforts to express themselves and may discourage them from trying to communicate altogether.

A. A serum prolactin level B. An endometrial biopsy C. A Papanicolaou test D. A vaginal ultrasound

Correct Answer is C

Explanation

A. This test is used to measure the level of prolactin, a hormone that stimulates milk production. It is not relevant for cervical cancer screening.
B. This test involves taking a sample of tissue from the lining of the uterus. It is used to diagnose endometrial cancer, not cervical cancer.
C. The Papanicolaou test, commonly known as a Pap smear, is the standard screening test for cervical cancer. It involves collecting cells from the cervix to detect any precancerous changes or cervical cancer itself. This is the correct answer, as it directly relates to cervical cancer screening.
D. This test uses sound waves to create images of the vagina and cervix. It can be used to evaluate the cervix for abnormalities, but it is not as sensitive as a Pap test for detecting cervical cancer.

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ABG Value	Normal Range
PH	7.35-7.45
PaCO2	35-45 mm Hg
HCO3-	22-26 mEq/L
Base excess	-2 to +2
PaO2	80-95 mm Hg
SaO2	>95%

A client returns to the surgical unit following a right modified radical mastectomy with dissection of axillary lymph nodes. An appropriate nursing intervention in the postoperative care for the client includes:

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse identifies the client problem of Impaired Verbal Communication for a client following a stroke who exhibits expressive aphasia. An appropriate nursing intervention to help the client to communicate is to:

Correct Answer is A

Explanation

A nurse is caring for a client who asks to be screened for cervical cancer because a relative has been diagnosed with it. Which of the following tests should the nurse expect the provider to use?

Correct Answer is C

Explanation

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The nurse is caring for an elderly female client who has an indwelling catheter. Which data in the assessment warrants notification of the health care provider?