A woman who has undergone a right-sided modified-radical mastectomy returns from surgery. Which nursing intervention would be most appropriate for the nurse to include in the client's plan of care at this time?

Encourage her to turn, cough, and deep breathe at frequent intervals.

Ask the client how she feels about having her breast removed.

Attach a sign above her bed to have BP, IV lines, and lab work on her right arm.

Position her right arm below heart level.

Answer and Explanation

The Correct Answer is A

Choice A: Encourage her to turn, cough, and deep breathe at frequent intervals. This intervention is appropriate for the nurse to include in the client's plan of care at this time because it can help prevent respiratory complications such as atelectasis (collapse of lung tissue) or pneumonia after surgery. Turning, coughing, and deep breathing can help expand the lungs, clear the airways, and improve oxygenation.

Choice B: Ask the client how she feels about having her breast removed. This intervention is not appropriate for the nurse to include in the client's plan of care at this time because it may be too intrusive or insensitive. Asking the client how she feels about having her breast removed may trigger emotional distress or anxiety in the client who has just undergone a major surgery that affects her body image and self-esteem. The nurse should wait until the client is more stable and ready to talk about her feelings and concerns.

Choice C: Attach a sign above her bed to have BP, IV lines, and lab work in her right arm. This intervention is not appropriate for the nurse to include in the client's plan of care at this time because it is incorrect and potentially harmful. Attaching a sign above her bed to have BP, IV lines, and lab work in her right arm may cause injury or infection to the arm that has undergone surgery and lymph node removal. The nurse should attach a sign above her bed to have BP, IV lines, and lab work in her left arm instead.

Choice D: Position her right arm below heart level. This intervention is not appropriate for the nurse to include in the client's plan of care at this time because it is incorrect and potentially harmful. Positioning her right arm below heart level may impair the blood circulation and lymphatic drainage of the arm that has undergone surgery and lymph node removal. The nurse should position her right arm above heart level instead.

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Correct Answer is B

Explanation

Choice A: Cancer is not the correct answer because it is not the leading cause of death among women. According to the World Health Organization, cancer accounted for 15% of all deaths among women in 2019.

Choice B: Heart Disease is the correct answer because it is the leading cause of death among women worldwide. According to the World Health Organization, heart disease accounted for 21% of all deaths among women in 2019. Many women are unaware of the risk factors and symptoms of heart disease, and may not seek timely medical attention. Therefore, educational programs that raise awareness and promote the prevention of heart disease are a priority for women's health.

Choice C: Diabetes is not the correct answer because it is not the leading cause of death among women. According to the World Health Organization, diabetes accounted for 4% of all deaths among women in 2019. However, diabetes can increase the risk of developing other complications such as heart disease, kidney disease, and blindness. Therefore, educational programs that teach women how to manage their blood sugar levels and prevent complications are important for women's health.

Choice D: Smoking is not the correct answer because it is not a condition, but a risk factor for many diseases. Smoking can increase the risk of developing lung cancer, heart disease, stroke, and chronic obstructive pulmonary disease. Therefore, educational programs that help women quit smoking and avoid exposure to secondhand smoke are beneficial for women's health.

A. "Don't worry, I will be with you during the exam." B. "What part of the exam makes you most nervous?" C. "All you need to do is relax." D. "A pelvic exam is required if you want birth control pills."

Correct Answer is B

Explanation

Choice A: "Don't worry, I will be with you during the exam." This response is not appropriate because it does not address the client's feelings or concerns. It also may sound dismissive or patronizing to the client, who may have valid reasons to be nervous.

Choice B: "What part of the exam makes you most nervous?" This response is appropriate because it shows empathy and interest in the client's perspective. It also invites the client to express her fears or questions and allows the nurse to provide information and reassurance.

Choice C: "All you need to do is relax." This response is not appropriate because it does not acknowledge the client's feelings or concerns. It also may sound unrealistic or insensitive to the client, who may find it hard to relax in a stressful situation.

Choice D: "A pelvic exam is required if you want birth control pills." This response is not appropriate because it does not address the client's feelings or concerns. It also may sound coercive or threatening to the client, who may feel pressured or intimidated by the requirement.

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A woman who has undergone a right-sided modified-radical mastectomy returns from surgery. Which nursing intervention would be most appropriate for the nurse to include in the client's plan of care at this time?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is working with a group of community health members to develop a plan to address the special health needs of women. The group would design educational programs to address which condition is the priority.

Correct Answer is B

Explanation

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Correct Answer is B

Explanation

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