A nurse is providing discharge teaching about lymphedema prevention to a client who is 2 days postoperative following a modified radical mastectomy. Which of the following instructions should the nurse include?

Apply lotion to the incisional site twice daily.

Avoid measuring blood pressure on the affected arm.

Apply deodorant under the affected arm daily.

Avoid lifting objects greater than 5.4 kg (12 lb).

Answer and Explanation

The Correct Answer is B

Choice A rationale:

Applying lotion to the incisional site may not be recommended as it could potentially irritate the incision or interfere with wound healing.

Choice B rationale:

Avoiding blood pressure measurements on the affected arm is important to prevent compromising lymphatic flow and potentially exacerbating lymphedema, a common complication after a modified radical mastectomy.

Choice C rationale:

Applying deodorant under the affected arm is discouraged, as it may contain chemicals that could irritate the surgical area.

Choice D rationale:

While lifting heavy objects is generally discouraged after surgery, the specific weight mentioned (5.4 kg or 12 lb) is not consistently supported as a limitation in post- mastectomy care.

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Correct Answer is B

Explanation

Choice A rationale:

High-impact exercises might not be suitable for all clients and could potentially exacerbate symptoms such as joint pain or discomfort.

Choice B rationale:

Menopause is confirmed after 12 consecutive months without a menstrual period. Until this point, there is still a risk of pregnancy, and contraceptive measures should be used.

Choice C rationale:

Pelvic muscle exercises (Kegel exercises) are important for strengthening pelvic floor muscles but are not specifically related to menopause.

Choice D rationale:

Using a water-based lubricant for painful vaginal intercourse is a helpful suggestion, but it is not the primary focus of menopause education.

A. Monitor the client's blood pressure daily. B. Allow the client to exercise once per week. C. Encourage the client to participate in group activities. D. Provide the client with high-calorie finger foods.

Correct Answer is D

Explanation

Choice A rationale:

This is not a priority intervention for a client who is in the manic phase of bipolar disorder. The nurse should monitor the client's vital signs as indicated, but blood pressure is not likely to be affected by mania unless the client has a preexisting condition or is taking medications that affect blood pressure.

Choice B rationale:

This is not an appropriate intervention for a client who is in the manic phase of bipolar disorder. The nurse should not restrict the client's physical activity, as this can increase their frustration and agitation. The nurse should provide a safe environment for the client to expend their energy and channel it into productive activities.

Choice C rationale:

This is not a suitable intervention for a client who is in the manic phase of bipolar disorder. The nurse should avoid stimulating the client's already elevated mood and arousal, as this can worsen their symptoms and increase their risk of injury or aggression. The nurse should limit the client's exposure to noise, crowds, and bright lights, and provide them with opportunities for rest and quiet time.

Choice D rationale:

A client who is in the manic phase of bipolar disorder has increased energy, activity, and metabolism, which can lead to weight loss and nutritional deficiencies. The nurse should provide the client with high-calorie finger foods that are easy to eat and do not require utensils or sitting down. This way, the nurse can help the client meet their nutritional needs while respecting their need for movement and autonomy.

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A nurse is providing discharge teaching about lymphedema prevention to a client who is 2 days postoperative following a modified radical mastectomy. Which of the following instructions should the nurse include?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is teaching a client who is experiencing manifestations of menopause. Which of the following instructions should the nurse include in the teaching?

Correct Answer is B

Explanation

A nurse is planning care for a client who is in the manic phase of bipolar disorder. Which of the following interventions should the nurse include?

Correct Answer is D

Explanation

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