A nurse is caring for a client who is 2 days postoperative following a total bilateralmastectomy. The client is tearful and looks away when her surgical dressings are removed. The nurse should place the priority on which of the following actions?
Demonstrating a nonjudgmental attitude toward the client when providing care for her surgical wounds
Providing the client with information on community resources that will strengthen her coping skills
Identifying the client's perception of the changes in her physical appearance
Encouraging the client to write about her feelings in a journal each day
The Correct Answer is C
The correct answer is C. Identifying the client's perception of the changes in her physical appearance is essential for developing a plan of care that addresses her psychosocial needs and promotes her self-esteem and body image. The client may experience grief, anger, depression, anxiety, or guilt after losing her breasts, which can affect her quality of life and recovery. The nurse should explore how the client feels about herself and her sexuality, and provide emotional support and empathy. The other actions are also important, but they are not as a priority as understanding how the client views herself.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
The correct answer is choice b. I will need to remain upright for 1 hour after taking the medication.
Choice A rationale:
Pantoprazole can be taken with or without food, so it does not need to be taken on an empty stomach.
Choice B rationale:
Remaining upright for at least 1 hour after taking pantoprazole helps prevent acid reflux and ensures the medication works effectively.
Choice C rationale:
Diarrhea is a possible side effect of pantoprazole, but it is not an expected outcome for all patients. If diarrhea occurs, it should be reported to a healthcare provider.
Choice D rationale:
Antacids can be taken with pantoprazole, but it is generally recommended to take them at different times to avoid potential interactions.
Correct Answer is D
Explanation
Answer: D. Elevated lipase
Rationale: Pancreatitis is an inflammation of the pancreas that causes pancreatic enzymes to leak into the bloodstream and damage surrounding tissues. Lipase is one of these enzymes that is produced by the pancreas to digest fats. An elevated lipase level indicates pancreatic injury and is a diagnostic marker for acute pancreatitis. The other laboratory results are not specific to pancreatitis and could be caused by other conditions.
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