A nurse is caring for a client who is at 33 weeks of gestation, has eclampsia, and is experiencing a seizure.
Which of the following actions should the nurse take following the seizure.

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

Carbonated beverages contain gas that expands the stomach, increasing pressure on the lower esophageal sphincter (LES). This increased pressure can cause the LES to relax and allow gastric contents to reflux into the esophagus, exacerbating heartburn. Additionally, the acidic nature of many carbonated drinks can irritate the already inflamed esophageal lining.

Choice B rationale

Hot herbal tea can relax the esophageal muscles and soothe irritation. However, some herbal teas, like peppermint, can relax the lower esophageal sphincter, potentially worsening reflux. In contrast, chamomile or ginger tea may have a calming effect on the stomach and reduce inflammation, which can alleviate the symptoms of heartburn.

Choice C rationale

High-fat snacks, especially those consumed at bedtime, delay gastric emptying. The presence of food in the stomach for a prolonged period increases the risk of gastric reflux. Delayed emptying leads to a larger volume of stomach contents exerting pressure on the lower esophageal sphincter, making it more likely to open and allow acid to escape.

Choice D rationale

Lying down after meals increases the pressure on the lower esophageal sphincter and places the stomach contents in a position where gravity no longer helps keep them down. This postural change makes it easier for stomach acid to flow back into the esophagus, which is a primary cause of heartburn. Remaining upright for at least 30 minutes after eating is recommended. *.