A nurse is contributing to the plan of care for a client who is postoperative following a below-the-knee amputation.
Which of the following strategies should the nurse include to help the client progress toward acceptance of this body image alteration?
Suggest that the client wear facility clothing until the prosthesis fitting.
Encourage the client to visit with someone who has had an amputation.
Discourage the client from touching the residual limb for the first week.
Reassure the client that the rehabilitation program is optional.
The Correct Answer is B
Encourage the client to visit with someone who has had an amputation.
This strategy can help the client cope with the loss of a body part and learn from the experience of others who have gone through a similar situation.
Choice A is wrong because suggesting that the client wear facility clothing until the prosthesis fitting can delay the client’s acceptance of the body image alteration and increase the risk of infection.
Choice C is wrong because discouraging the client from touching the residual limb for the first week can interfere with the healing process and prevent the client from becoming familiar with the new body part.
Choice D is wrong because reassuring the client that the rehabilitation program is optional can discourage the client from participating in physical therapy and hinder the recovery and adaptation.
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Correct Answer is B
Explanation
Prepare the client for a cesarean birth.
This is because the client has herpes simplex virus with active lesions, which can be transmitted to the newborn during vaginal delivery and cause serious complications such as neonatal herpes infection. A cesarean birth can prevent this transmission and protect the newborn’s health.
Choice A is wrong because an amnioinfusion is a procedure that involves infusing fluid into the amniotic cavity to increase the volume of amniotic fluid and reduce cord compression.
It is not indicated for a client with herpes simplex virus with active lesions.
Choice C is wrong because ampicillin is an antibiotic that is used to treat bacterial infections, not viral infections such as herpes simplex virus.
Ampicillin will not prevent the transmission of herpes simplex virus to the newborn.
Choice D is wrong because oxytocin is a hormone that stimulates uterine contractions and can be used to augment or induce labor.
It is not indicated for a client with herpes simplex virus with active lesions, as it can increase the risk of transmission to the newborn by prolonging the exposure to infected genital secretions.
Correct Answer is B
Explanation
It occurs because nicotine stimulates the release of dopamine, a neurotransmitter that regulates mood and pleasure. When nicotine intake is stopped, dopamine levels drop and cause anxiety and irritability.
Choice A is wrong because tachycardia, or rapid heart rate, is not a symptom of nicotine withdrawal. In fact, smoking can increase blood pressure and heart rate, so quitting smoking may lower them.
Choice C is wrong because weight loss is not a symptom of nicotine withdrawal. On the contrary, weight gain is more likely to occur after quitting smoking, because nicotine suppresses appetite and increases metabolism.
Choice D is wrong because vomiting is not a symptom of nicotine withdrawal. Vomiting may be a side effect of some nicotine replacement therapies, such as patches or gum, but it is not caused by the lack of nicotine itself.
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