A nurse is preparing to discharge an older adult patient who had a mastectomy several months ago. The client tells the nurse that she has not had much desire for sexual relations since her surgery, stating, "my body is so different now." Which of the following is an appropriate response by the nurse?

"It is still too soon to expect to feel normal. Give it a few more years."

"Really, you look just fine to me. There's no need to feel undesirable."

"Consider an afternoon at the spa. A facial will make you feel more attractive."

"I'm interested in finding out more about how your body feels to you."

Answer and Explanation

The Correct Answer is D

Choice A reason: Telling the client it is too soon to expect to feel normal and to give it a few more years dismisses her feelings and provides an unrealistic timeline. It is not supportive or empathetic.

Choice B reason: Saying "Really, you look just fine to me. There's no need to feel undesirable" invalidates the client's feelings and does not address her concerns about her body image and sexual desire.

Choice C reason: Suggesting an afternoon at the spa and a facial to make her feel more attractive trivializes the client's emotional and physical experience post-surgery. It does not provide meaningful support or address the underlying issues.

Choice D reason: Expressing interest in how the client's body feels to her validates her feelings and opens up a dialogue for her to share her concerns. This approach is empathetic and allows the nurse to provide better support and address any issues the client might have.

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Correct Answer is D

Explanation

Choice A reason: Telling the client they will not need any special treatment after surgery is inaccurate. Bilateral adrenalectomy results in the removal of both adrenal glands, which produce essential hormones.

Choice B reason: Chemotherapy is not a standard post-surgical treatment for an adrenalectomy unless there is a specific indication. This statement may cause unnecessary concern for the client.

Choice C reason: An abdominal binder is not typically required after a bilateral adrenalectomy. This information is not relevant to the client's post-surgical needs.

Choice D reason: After a bilateral adrenalectomy, the client will need daily hormone replacement medications for life, as the adrenal glands are responsible for producing essential hormones like cortisol and aldosterone

A. "You should skip one weight check post-dialysis." B. "You should warm the dialysate solution before instillation." C. "You should pack the catheter exit site with gauze." D. "You should avoid foods high in potassium."

Correct Answer is B

Explanation

Choice A reason: Skipping a weight check post-dialysis is not recommended. Monitoring weight is crucial to assess fluid balance and effectiveness of dialysis.

Choice B reason: Warming the dialysate solution before instillation is important to prevent discomfort and cramping during the dialysis process. This ensures the solution is at body temperature.

Choice C reason: Packing the catheter exit site with gauze is not recommended. The site should be kept clean and dry, with proper sterile dressing.

Choice D reason: Avoiding foods high in potassium is more relevant for clients on hemodialysis rather than peritoneal dialysis. Clients on peritoneal dialysis have fewer dietary restrictions regarding potassium.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is caring for a client scheduled for a bilateral adrenalectomy for treatment of an adrenal tumor. What information should the nurse give the client about the post-surgical needs?

Correct Answer is D

Explanation

A nurse is providing discharge teaching for a client who is to perform peritoneal dialysis at home. Which information should the nurse include?

Correct Answer is B

Explanation

A client with myxedema reports experiencing fatigue, cold intolerance, and swelling around the eyes and face. The nurse plans care, understanding that these clinical manifestations are caused by a lack of or diminished production of which hormones? (Select all that apply)

A client is admitted to the hospital with a myasthenic crisis. The nurse should anticipate which potential precipitating factors for this event?

The nurse is caring for a patient with a blood pressure of 88/50 and symptomatic. The nurse recognizes which nursing action is a priority?

A nurse evaluates a client who presents to the provider's office to assess multiple nevi. Which finding should the nurse highlight to the provider as a possible sign of malignancy?

A nurse in the med-surgical ICU is assessing a client in the oliguric phase of acute kidney injury. Which of the following findings should the nurse expect?

The nurse is caring for a client who was prescribed digoxin. Which manifestations correlate with a digoxin level of 3.0 (Range: 0.8-2.0)? (Select all that apply)

The nurse is assessing a client's eyes and notes that when the client looks at a near object, the pupil constricts, but when the client looks at an object in the distance, the pupil dilates. The nurse should identify this finding as which condition?

The nurse is preparing the client assignments for the day to a licensed practical nurse (LPN) and an unlicensed assistive personnel (UAP). Which client should the nurse assign to the LPN? (Select all that apply)