A nurse is caring for a client who has breast cancer and is postoperative following a bilateral mastectomy. Which of the following statements indicates the client has an altered body image?

Choice A reason: High-osmolarity formulas may cause diarrhea but are not directly linked to aspiration risk. Aspiration results from improper positioning or reflux, not formula osmolarity, so this factor is less relevant, making it incorrect for identifying aspiration risk in enteral feedings.
Choice B reason: Sitting in high-Fowler’s position (60-90 degrees) reduces aspiration risk by promoting gastric emptying and preventing reflux during enteral feedings. This is a protective measure, not a risk factor, making it incorrect for this scenario.
Choice C reason: A residual of 65 mL 1 hour postprandial is within acceptable limits (<100-200 mL, per facility protocol) and does not indicate high aspiration risk. Elevated residuals may suggest delayed emptying, but this value is normal, making it incorrect.
Choice D reason: A history of gastroesophageal reflux disease increases aspiration risk, as reflux can allow gastric contents to enter the airway during enteral feedings. This condition compromises esophageal sphincter function, making it a significant risk factor and the correct choice.

Choice A reason: Avoiding physical exercise is not recommended for multiple sclerosis, as moderate activity like walking or stretching improves muscle strength, balance, and fatigue management. Complete avoidance leads to deconditioning, worsening mobility and fatigue, which are common in MS, making this instruction counterproductive to symptom management.
Choice B reason: Taking hot baths is not advised for multiple sclerosis, as heat can exacerbate symptoms like fatigue and muscle weakness due to temperature sensitivity (Uhthoff’s phenomenon). Cool or lukewarm baths are safer, supporting symptom control, making this instruction harmful and inappropriate for MS management.
Choice C reason: Performing daily stretching exercises improves flexibility, reduces spasticity, and enhances mobility in multiple sclerosis. Stretching strengthens muscles and prevents contractures, supporting functional independence. This aligns with evidence-based MS management to mitigate symptoms and improve quality of life, making it the correct instruction.
Choice D reason: Limiting fluid intake to reduce bladder irritation is inappropriate, as adequate hydration (2-3 L/day) prevents urinary tract infections, common in MS due to bladder dysfunction. Fluid restriction can worsen symptoms and dehydration, making this instruction incorrect for managing MS-related bladder issues effectively.