A nurse is caring for a client who is scheduled for a mastectomy. The client tells the nurse. "I'm not sure I want to have a mastectomy." Which of the following statements should the nurse make?
"I can give you a list of other people who had the same procedure."
“can give you additional information about the procedure."
“You will be cancer-free if you have the procedure
“You should get a second opinion regarding the procedure."
The Correct Answer is B
Choice A Reason:
"I can give you a list of other people who had the same procedure." - This response might not address the client's concerns and could potentially violate privacy and confidentiality.
Choice B Reason:
"I can give you additional information about the procedure." Response B is an appropriate and supportive response. The client is expressing uncertainty about the mastectomy, so offering more information about the procedure can help the client make an informed decision. Providing accurate and detailed information allows the client to better understand their options and the potential benefits and risks of the procedure.
Choice C Reason:
"You will be cancer-free if you have the procedure." - Making a guarantee of being cancer-free after the procedure might be misleading and overly optimistic. While a mastectomy can treat cancer in some cases, it's important to provide realistic information.
Choice D Reason:
"You should get a second opinion regarding the procedure." - While seeking a second opinion can be valuable, this response might not directly address the client's immediate concerns about the procedure. Providing information first and then discussing the option of a second opinion might be a more balanced approach.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A Reason:
The client reports being extremely thirsty with a sore throat - This could be due to the presence of the NG tube and suctioning, but it is not as immediately concerning as the change in drainage colour.
Choice B Reason:
The client's abdomen becomes distended and firm - While this could indicate a possible complication, it is not as directly related to the change in drainage colour.
Choice C Reason:
The drainage is bright green in colour with brown faecal material the finding that the drainage from the NG tube is bright green in colour with brown faecal material should be reported to the provider. This change in the colour and appearance of the drainage can be indicative of bilious (greenish-yellow) vomiting, which may suggest an obstruction or another underlying issue. It's important to assess the client's condition and inform the provider about any significant changes in their symptoms.
Choice D Reason:
The amount of drainage is gradually decreasing - Gradually decreasing drainage could be expected as the condition improves, but it's not as alarming as a change in the drainage colour.
Correct Answer is A
Explanation
Placing the client in high-Fowler's position is the appropriate action. When administering peritoneal dialysis, the nurse should place the client in a high-Fowler's position. This position helps promote the flow of dialysate into and out of the peritoneal cavity and assists with proper drainage. The high-Fowler's position allows for gravity to aid in the movement of fluid and helps prevent leakage of fluid back into the catheter.
Choice B Reason:
Chilling the dialysate before administration is not necessary and could cause discomfort to the client. Dialysate should be warmed to body temperature before use.
Choice C Reason:
Hanging the drainage bag below the client's abdomen is incorrect. The drainage bag should be positioned below the level of the abdomen to allow for proper drainage by gravity, but it should not be hung too low as this can lead to excessive drainage and dehydration.
Choice D Reason:
Using clean technique to access the catheter is incorrect. Sterile technique is required when accessing the peritoneal dialysis catheter to prevent infection. Peritoneal dialysis involves direct access to the peritoneal cavity, which is considered a sterile body cavity.
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