Nokea
On the fourth postoperative day after a modified radical mastectomy, the nurse finds the patient with her back to the nurse. She is crying and tells the nurse she feels ugly and is worried that her husband will not be in love with her anymore. The nurse recognizes the interventions in the plan of care will be based which patient problem?
- A. Difficulty accepting the change in body image
- B. Fear, due to inadequate preoperative education.
- C. Mood swings, due to inability to interact with others
- D. Fear of dying, due to the diagnosis of breast cancer
Correct Answer: A
Rationale: After losing a breast, many patients experience grief over the loss of a body part. The process of grieving is essential for personal adaptation to the loss. The nurse can assist the patient to find helpful coping mechanisms.
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Select the intervention that should be performed with caution, in the affected arm, on patients who have undergone a modified radical mastectomy.
- A. Vaccinations
- B. Taking of blood pressure or samples
- C. Insertion of IV line
- D. Physical therapy on uninvolved arm
- E. Wear watch and jewelry on involved arm
- F. Carry purse on involved arm or shoulder
Correct Answer: A,B,C
Rationale: Patients should be taught not to have any procedures involving the arm on the affected side-BP readings, injections, intravenous infusion of fluids, or the drawing of blood, which may cause edema or infection-and to guard against infections from burns, needle pricks (sewing), and gardening injuries.
Which statement is TRUE regarding diagnostic tests for cervical cancer?
- A. All persons who have a cervix remaining should be screened up to the age of 75.
- B. Cervical cancer screening should begin at 25 years of age
- C. Traditional Pap tests are less than 30% accurate in screening for cervical cell abnormalities
- D. False-positive and false-negative results rarely occur with traditional Pap diagnostic tests.
Correct Answer: B
Rationale: The American Cancer Society recommends that annual cervical cancer screening begin at 25 years of age. Pap tests are less than 100% accurate in screen for abnormalities.
The patient reports that she is free of gonorrhea and can now engage in sexual activity. Which response is most appropriate?
- A. If you have been free of symptoms for 2 weeks you are cured.'
- B. You should get a rapid plasma reagin (RPR) just to make sure.'
- C. No case is considered cured until you have had three consecutive negative cervical smears.'
- D. To confirm your cure, you should get a Venereal Disease Research Lab (VDRL).'
Correct Answer: C
Rationale: No case of gonorrhea is considered cured until you have had three consecutive negative cervical smears. The RPR and the VDRL are tests for syphilis.
Which statement indicates that the patient who has had an abdominal hysterectomy needs further home teaching?
- A. I understand I can lift as much as 20 lb.'
- B. I'm leaving today to stay with my daughter who lives 20 miles away. My husband plans to drive the family car.'
- C. The health care provider said I can't have sexual intercourse for 4 to 6 weeks.'
- D. I'm going to miss wearing my girdle or knee-high hose.'
Correct Answer: A
Rationale: If there has been an abdominal incision, there may be further restrictions on heavy lifting (nothing over 10 lb).
The nurse gives discharge instructions to a person who has had a modified radical mastectomy of the right side to perform the 'elbow pull-in.' Which step is the first step of the exercise?
- A. Pull elbows forward until they touch.
- B. Lower and straighten the arms.
- C. Extend arms sideways to shoulder level.
- D. Bring elbows back and extend arms.
- E. Clasp hands behind neck.
Correct Answer: C
Rationale: The exercise requires that you bring the arms out at shoulder level, clasp hands behind head and bring elbows to touch, then bring elbows back and extend arms lower and straighten arms.