A nurse is caring for a client who is one day postoperative following a left radical mastectomy. Which of the following behaviors should alert the nurse to the possibility that the client is having difficulty adjusting to the loss of her breast?
Refusing to look at the dressing or surgical incision
Asking questions about the information on her postoperative care pamphlet
Performing arm exercises once or twice a day
Asking for pain medication every 3 hours
The Correct Answer is A
Choice A: Refusing to look at the dressing or surgical incision is the correct answer because it is a behavior that may indicate difficulty adjusting to the loss of her breast. Refusing to look at the dressing or surgical incision may reflect denial, avoidance, or fear of facing the reality of the surgery and its consequences. It may also indicate low self-esteem, body image disturbance, or depression. The nurse should assess the client's emotional state and provide support and education.
Choice B: Asking questions about the information on her postoperative care pamphlet is not the correct answer because it is a behavior that may indicate a positive adjustment to the loss of her breast. Asking questions about the information on her postoperative care pamphlet may reflect acceptance, curiosity, or motivation to learn about her condition and treatment. It may also indicate high self-efficacy, coping skills, or optimism. The nurse should encourage the client's involvement and provide clear and accurate information.
Choice C: Performing arm exercises once or twice a day is not the correct answer because it is a behavior that may indicate a positive adjustment to the loss of her breast. Performing arm exercises once or twice a day may reflect compliance, responsibility, or self-care. It may also indicate physical recovery, functional ability, or quality of life. The nurse should reinforce the client's efforts and provide feedback and guidance.
Choice D: Asking for pain medication every 3 hours is not the correct answer because it is a behavior that may indicate a normal response to the loss of her breast. Asking for pain medication every 3 hours may reflect pain management, comfort, or relief. It may also indicate trust, communication, or satisfaction with care. The nurse should assess the client's pain level and provide adequate and timely pain relief.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","C","E"]
Explanation
Choice A: Sleep disturbances are the correct answer because they are a symptom of a heart attack observed in women. Sleep disturbances are problems that affect the quality or quantity of sleep, such as insomnia, nightmares, or snoring. They can indicate that the heart is not pumping enough blood and oxygen to meet the body's needs during sleep. About 48% of women who have had a heart attack report having sleep disturbances in the weeks before their event.
Choice B: Syncope is not the correct answer because it is not a symptom of a heart attack observed in women. Syncope is a condition that causes a temporary loss of consciousness due to a drop in blood pressure or blood flow to the brain. It can be caused by various factors such as dehydration, medication side effects, or cardiac arrhythmias. However, it is not a common sign of a heart attack in women and only about 12% of women who have had a heart attack report having syncope before their event.
Choice C: Unusual fatigue is the correct answer because it is a symptom of a heart attack observed in women. Unusual fatigue is a feeling of extreme tiredness or exhaustion that is not relieved by rest or sleep. It can indicate that the heart is not pumping enough blood and oxygen to meet the body's needs during daily activities. About 70% of women who have had a heart attack report having unusual fatigue in the weeks before their event.
Choice D: Extreme hunger is not the correct answer because it is not a symptom of a heart attack observed in women. Extreme hunger is a feeling of intense or excessive appetite or craving for food. It can be caused by various factors such as diabetes, thyroid disorder, or stress. However, it is not a sign of a heart attack in women, and only about 4% of women who have had a heart attack report having extreme hunger before their event.
Choice E: Arm pain is the correct answer because it is a symptom of a heart attack observed in women. Arm pain is a feeling of discomfort or ache in one or both arms, especially the left arm. It can indicate that the heart muscle is not receiving enough blood and oxygen due to a blocked coronary artery. About 42% of women who have had a heart attack report having arm pain before their event.
Correct Answer is B
Explanation
Choice A: "If your sexual partner has no symptoms, no medication is needed." This statement is false and misleading. Chlamydia is a sexually transmitted infection (STI) that can cause serious complications such as pelvic inflammatory disease (PID), infertility, ectopic pregnancy, and chronic pelvic pain if left untreated. Chlamydia can also be passed on to newborns during delivery, causing eye infections or pneumonia. Therefore, it is important that both the client and their sexual partner(s) receive treatment and abstain from sexual activity until they are cured.
Choice B: "This infection is treated with one dose of azithromycin." This statement is true and accurate. Azithromycin is an antibiotic that can effectively treat chlamydia with one oral dose. However, some people may experience side effects such as nausea, vomiting, diarrhea, or abdominal pain after taking azithromycin. Therefore, it is important that the client follows the instructions and completes the treatment as prescribed.
Choice C: "You need to return in 6 months for retesting." This statement is false and unnecessary. Retesting for chlamydia is recommended only if the client has symptoms, has a new or multiple sexual partner(s), or is pregnant. Otherwise, retesting is not required if the client and their partner(s) have completed the treatment and have no further exposure to chlamydia.
Choice D: "You have to avoid sexual relations for 3 days." This statement is false and insufficient. The client should avoid sexual relations until they and their partner(s) have completed the treatment and have no symptoms of chlamydia. This may take longer than 3 days, depending on the type and duration of the treatment. Therefore, it is advisable that the client uses condoms or abstains from sexual activity until they are cured.
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