A nurse is providing teaching to a client who is postoperative following a mastectomy of the left breast with axillary lymph node dissection. Which of the following exercises should the nurse instruct the client to start on the first postoperative day?

Answer: D. A client whose medications to manage Parkinson's disease are no longer effective.

Rationale:

A) A client who is newly diagnosed with type 1 diabetes mellitus and cannot afford insulin:

While this client has a significant medical issue, the primary concern here is financial rather than palliative. Palliative care focuses on providing relief from symptoms and improving quality of life for those with serious illnesses. Addressing the client's financial issues might involve social services or community resources rather than palliative care.

B) A client who has Meniere's disease and cannot safely ambulate due to vertigo:

Meniere's disease, while debilitating, may not necessarily require palliative care unless the symptoms are severely impacting the client's quality of life in a way that is not manageable with current treatments. Palliative care could be considered if the disease is severely limiting function and other supportive care is needed.

C) A client who had a stroke and cannot eat or drink without choking:

This client is experiencing a significant functional impairment due to the stroke, which might benefit from rehabilitative services rather than palliative care. Palliative care would be more appropriate if the client's condition is progressive, severe, and not responsive to treatment, leading to a focus on comfort and quality of life.

D) A client whose medications to manage Parkinson's disease are no longer effective:

When medications for Parkinson's disease are no longer effective, the client may be experiencing advanced symptoms and a decline in quality of life. Palliative care can provide symptom management, support, and enhance the client's quality of life when conventional treatments are no longer effective in controlling symptoms.

Choice A rationale:
(Potassium level) Lovastatin is a medication used to treat high cholesterol levels. While potassium levels are important to monitor for certain conditions, they are not directly related to the initiation of lovastatin therapy. Therefore, this is not the correct choice for diagnostic testing before starting the medication.
Choice B rationale:
(Hemoglobin level) Hemoglobin levels are important to assess for anemia or other blood disorders. However, they are not specifically required before starting lovastatin therapy. Therefore, this is not the correct choice for diagnostic testing before starting the medication.
Choice C rationale:
(Kidney function tests) While kidney function tests are essential for many medications to ensure proper excretion and avoid toxicity, they are not directly related to the initiation of lovastatin therapy. Therefore, this is not the correct choice for diagnostic testing before starting the medication.
Choice D rationale:
(Liver function tests) Liver function tests are crucial before starting lovastatin therapy. Lovastatin is metabolized in the liver, and it can potentially cause liver damage or abnormalities in liver enzymes. Monitoring liver function helps detect any pre-existing liver conditions and ensures the safe use of the medication. Therefore, this is the correct choice for diagnostic testing before starting the medication.