A nurse is providing discharge teaching to a client following a modified left mastectomy. Which statements by the client indicate an understanding of the teaching?
"I will keep my left arm flexed at the elbow as much as possible."
"I will have to wait 2 months before additional saline can be added to my breast expander."
"should expect less than 25 mL of secretions per day in the drainage devices."
"I will perform strength-building arm exercises using a 15-pound weight."
The Correct Answer is B
Choice A reason:
"will keep my left arm flexed at the elbow as much as possible": This statement is incorrect because after a mastectomy, it's important to promote full range of motion in the affected arm to prevent complications like contractures and lymphedema.
Choice B reason:
“will have to wait 2 months before additional saline can be added to my breast expander" This is the correct statement. Following a modified radical mastectomy with a breast expander, additional saline is often added gradually to the expander to stretch the skin and muscle for reconstruction. The waiting period between saline additions allows for healing and proper tissue expansion. This statement indicates that the client understands the postoperative care and timeline.
Choice C reason:
"should expect less than 25 ml of secretions per day in the drainage devices": This statement is not accurate because the drainage amount can vary, and 25 ml per day might not be an accurate estimate.
Choice D reason:
"will perform strength-building arm exercises using a 15-pound weight": This statement is not appropriate, especially shortly after surgery. Gradual and gentle strength-building exercises are recommended, and using a 15-pound weight could be too strenuous and potentially harmful.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason:
Bradycardia is incorrect. Bradycardia refers to a slow heart rate, and while anaemia can lead to an increased heart rate (tachycardia) as the body tries to compensate for the decreased oxygen levels, it is not typically associated with bradycardia.
Choice B reason:
Headache Anaemia is a condition characterized by a decreased number of red blood cells or a decrease in the amount of haemoglobin in the blood, leading to reduced oxygen-carrying capacity. This can result in decreased oxygen delivery to various tissues and organs, including the brain. As a result, clients with anaemia often experience symptoms such as fatigue, weakness, and headaches.
Choice C reason:
Flushed skin colour - Anaemia is more likely to cause paleness of the skin (pallor) due to the decreased haemoglobin levels, rather than flushed skin colour.
Choice D reason:
Heat intolerance - Heat intolerance is not a typical symptom of anaemia. It might be seen in conditions affecting the thyroid or related to hormonal imbalances, but it is not directly related to anaemia.
Correct Answer is A
Explanation
Choice A Reason:
Wearing a lead apron when providing client care is appropriate. When caring for a client who is receiving internal radiation therapy, the nurse should take appropriate safety measures to minimize their exposure to radiation. Wearing a lead apron when providing care to the client helps shield the nurse's body from radiation exposure and reduces the risk of harm.
Choice B Reason:
Allowing visitors to hold the client's hand is inappropriate. Visitors should also be educated about radiation safety measures and should not be encouraged to have close contact with the client during internal radiation therapy.
Choice C Reason:
Leaving the door to the client's room open is inappropriate. Closing the door to the client's room can help contain radiation and limit its spread to other areas.
Choice D Reason:
Placing the dosimeter badge on the client's bed is inappropriate. The dosimeter badge should be worn by healthcare personnel to measure their radiation exposure. Placing it on the client's bed does not accurately measure the nurse's exposure and is not the correct use of the badge.
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