The nurse is providing care for a patient who had a mastectomy for breast cancer 2 days ago. What should the nurse include in the daily care?
Empty the drain device every shift.
Minimize use of the affected arm.
Measure the circumference of both arms.
Place the affected arm below the level of the heart.
The Correct Answer is A
Choice A reason: Emptying the drain device every shift is important to prevent infection and accumulation of fluid, which can impede healing.
Choice B reason: Minimizing use of the affected arm is not recommended; rather, gentle exercises to promote circulation and prevent lymphedema are usually encouraged.
Choice C reason: Measuring the circumference of both arms can be part of monitoring for lymphedema, but it is not the priority in immediate post-mastectomy care.
Choice D reason: Placing the affected arm below the level of the heart is not recommended as it can increase swelling; elevation is usually advised.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["C","D","E","F"]
Explanation
Choice A reason: LPNs are involved in developing the patient's plan of care by gathering data and collaborating with the RN to ensure the plan is tailored to the patient's needs.
Choice B reason: Providing informed consent is typically the responsibility of the physician or advanced practice nurses, not the LPN.
Choice C reason: LPNs provide emotional support to patients, helping to alleviate anxiety and offering comfort before the surgery.
Choice D reason: LPNs assist with data collection, such as gathering vital signs and medical history, which is crucial for the preoperative assessment.
Choice E reason: Including families in preoperative care is part of the holistic approach to nursing, where LPNs can provide information and support to the patient's family.
Choice F reason: LPNs reinforce patient teaching by reviewing instructions and care plans with the patient and their family to ensure understanding and compliance.
Correct Answer is B
Explanation
Choice A reason: Cool, dry skin is not typically associated with a panic attack, which often involves symptoms like sweating due to the fight-or-flight response.
Choice B reason: Chest pain is a common symptom of panic attacks, often leading individuals to believe they are having a heart attack.
Choice C reason: Pallor, or paleness, may occur during a panic attack, but it is not as common as other symptoms like chest pain.
Choice D reason: Bradycardia, or slow heart rate, is not characteristic of a panic attack; tachycardia, or fast heart rate, is more common.
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