A nurse is assessing a client who has a sliding hiatal hernia.
Which of the following findings should the nurse expect?

Choice A rationale

Beginning ball-squeezing exercises is a correct instruction. These exercises, along with others like wall climbing, are essential to promote lymphatic drainage and restore range of motion in the arm on the affected side. Starting these early helps prevent the development of lymphedema, a common complication of mastectomy, by facilitating circulation and reducing fluid accumulation.

Choice B rationale

Wearing a bra with wire support is incorrect. Post-mastectomy, a client should be advised to wear a soft, supportive, and non-restrictive bra, preferably without underwire. Underwire can cause pressure and irritation on the incision site, potentially delaying healing and increasing the risk of lymphedema by compressing lymphatic vessels, which impedes the proper flow of lymph.

Choice C rationale

Avoiding using the affected arm for eating is incorrect. Gentle use of the affected arm for activities of daily living, such as eating and dressing, is encouraged early on to promote mobility and prevent stiffness. The key is to avoid strenuous activities and heavy lifting, but using the arm for routine tasks is beneficial for maintaining function and promoting recovery.

Choice D rationale

Using deodorant under the affected arm is incorrect. After a modified radical mastectomy, the client should be advised to avoid applying deodorant, lotions, or creams to the axilla on the surgical side. The skin in this area is often sensitive and prone to irritation, and these products can introduce bacteria, increasing the risk of infection and interfering with the healing process of the surgical site. .

Choice A rationale

Informed consent is a dynamic and ongoing process, not a one-time event. A client has the autonomous right to refuse a procedure at any point, even after having previously signed a consent form. This right is based on the principle of client autonomy, which states that competent individuals have the right to make decisions about their own healthcare, including the right to withdraw consent at any time. The signed form simply documents that the discussion occurred; it does not nullify the client's right to change their mind.

Choice B rationale

The ability to write is not a prerequisite for providing informed consent. A client who is unable to write can still provide verbal consent, and this is typically documented by a witness. The key components of informed consent are the client's understanding of the procedure and their voluntary agreement. As long as the client can comprehend the information and communicate their decision, they are considered capable of providing consent. A mark or a signature from a witnessed verbal consent can be used to formalize the documentation process.

Choice C rationale

A client who is blind is fully capable of providing informed consent as long as they can understand the information being presented. The nurse or healthcare provider must ensure that the information is communicated in a manner the client can comprehend, which may include reading the consent form aloud and answering any questions. The visual impairment does not compromise the client's cognitive ability to make decisions about their own healthcare, and therefore, a guardian is not required for this reason.

Choice D rationale

While a nurse can and often does clarify information, the primary responsibility for explaining surgical risks and benefits to a client lies with the surgeon or the healthcare provider performing the procedure. The physician must provide a comprehensive explanation of the procedure, including all potential risks, benefits, and alternatives, to ensure the client is fully informed. The nurse's role is to act as a witness to the signature and to ensure the client has had their questions answered, and to notify the provider if they have new questions or concerns. *.