A client with breast cancer who received chemotherapy two weeks ago returns to the clinic for follow-up. Which priority follow-up assessment should the practical nurse (PN) anticipate for this client?

Choice A reason: Demonstrating the use of an incentive spirometer is a valuable intervention for encouraging deep breathing and preventing atelectasis. However, in the context of a client with absent breath sounds on one side, the priority is to monitor for signs of respiratory distress or complications such as a pneumothorax. While using an incentive spirometer may be beneficial in other scenarios, it is not the immediate priority in this case.
Choice B reason: Monitoring the client for increasing respiratory distress is the most critical action to take. The absence of breath sounds on the left side could indicate a serious complication such as a pneumothorax, hemothorax, or other issues that can compromise respiratory function. By closely monitoring the client, the practical nurse can detect signs of worsening condition, such as increased work of breathing, cyanosis, or changes in vital signs, and provide timely intervention or support while awaiting the healthcare provider's arrival.
Choice C reason: Administering a PRN dose of a diuretic medication is not appropriate in this context. Diuretics are used to manage fluid balance and treat conditions such as heart failure or hypertension but are not relevant for addressing the immediate concern of absent breath sounds and potential respiratory distress. The focus should remain on monitoring the client's respiratory status and ensuring appropriate interventions are available if needed.
Choice D reason: Encouraging the client to use pursed-lip breathing can be beneficial for clients experiencing shortness of breath or for managing chronic obstructive pulmonary disease (COPD). However, in the case of absent breath sounds on one side, it is more important to monitor for signs of respiratory compromise and ensure the client receives prompt medical evaluation and intervention. Pursed-lip breathing is not the immediate priority in this scenario.

Choice A reason: Asking if the client understands the consequences of continuing to smoke is essential for assessing his level of awareness about the risks associated with smoking, especially after a myocardial infarction. This step helps gauge the client's knowledge and can serve as a starting point for providing further education. It opens up a dialogue where the nurse can discuss the detrimental effects of smoking on cardiovascular health and the increased risk of recurrent heart attacks. Understanding the client's perspective and providing education can foster a more informed decision-making process and may encourage the client to consider quitting smoking.
Choice B reason: Encouraging the client to substitute cigars for cigarettes is not a recommended intervention. Cigars, like cigarettes, contain nicotine and other harmful chemicals. Substituting one form of tobacco for another does not reduce the health risks associated with smoking. Cigars can also lead to nicotine addiction and contribute to heart disease and other health issues. The goal should be to support the client in achieving complete smoking cessation rather than replacing one harmful habit with another. This approach does not align with evidence-based practices for promoting health and reducing cardiovascular risks.
Choice C reason: Recommending an acupuncturist to assist with smoking cessation efforts is an alternative therapy that some individuals may find beneficial. However, it should not be the first-line recommendation. Evidence-based strategies such as nicotine replacement therapy, medications, and counseling should be prioritized. Acupuncture can be considered as a complementary therapy in conjunction with these proven methods. It is important to provide the client with a range of options and support them in choosing the most effective and suitable approach for smoking cessation. However, this option alone does not address the immediate need for education and support regarding the risks of continued smoking.
Choice D reason: Reinforcing information about the consequences related to smoking and heart disease is crucial. Education plays a significant role in helping the client understand the impact of smoking on cardiovascular health. Providing detailed information about how smoking contributes to heart disease, the benefits of quitting, and the potential for improved outcomes can motivate the client to consider cessation. Reinforcement of this information helps to ensure that the client is fully aware of the serious health risks and the importance of quitting smoking to prevent further cardiovascular events.
Choice E reason: Recording the client's exact words in the electronic medical record is important for accurate documentation and continuity of care. This documentation provides a clear record of the client's statements, attitudes, and intentions regarding smoking. It ensures that all members of the healthcare team are informed of the client's position and can tailor their interventions accordingly. Accurate documentation also helps in tracking the client's progress and responses to interventions over time, facilitating a coordinated and comprehensive approach to care.