A nurse is caring for a client who is 2 days postoperative following a total bilateralmastectomy. The client is tearful and looks away when her surgical dressings are removed. The nurse should place the priority on which of the following actions?

Demonstrating a nonjudgmental attitude toward the client when providing care for her surgical wounds

Providing the client with information on community resources that will strengthen her coping skills

Identifying the client's perception of the changes in her physical appearance

Encouraging the client to write about her feelings in a journal each day

Answer and Explanation

The Correct Answer is C

The correct answer is C. Identifying the client's perception of the changes in her physical appearance is essential for developing a plan of care that addresses her psychosocial needs and promotes her self-esteem and body image. The client may experience grief, anger, depression, anxiety, or guilt after losing her breasts, which can affect her quality of life and recovery. The nurse should explore how the client feels about herself and her sexuality, and provide emotional support and empathy. The other actions are also important, but they are not as a priority as understanding how the client views herself.

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Correct Answer is C

Explanation

Choice A option:

Dietitian should not be consulted: The dietitian is an essential team member and will work closely with the client to ensure proper nutrition and dietary management. However, in the context of dysphagia, the speech-language pathologist's expertise is needed to determine safe swallowing strategies and food modifications.

Choice B option:

Physical therapist should not be consulted: The physical therapist focuses on maintaining and improving the client's physical function and mobility. While important in ALS management, the physical therapist's role is not directly related to the immediate issue of dysphagia.

Choice C option:

The speech-language pathologist is the correct answer because it specializes in assessing and treating communication and swallowing disorders. In this case, the speech-language pathologist is essential in evaluating the client's swallowing function, recommending appropriate dietary modifications (texture and consistency of foods), and implementing swallowing exercises or strategies to improve swallowing safety.

Choice D option:

Occupational therapist should not be consulted: The occupational therapist assists clients in regaining or maintaining independence in daily living activities. While the occupational therapist may address some aspects of mealtime activities and adaptive strategies, the speech-language pathologist is more specialized in evaluating and treating swallowing difficulties in clients with ALS.

A. Increased haemoglobin level B. Increased platelet count C. Increased neutrophil count D. Increased erythrocyte sedimentation rate

Correct Answer is A

Explanation

Choice A reason:

Increased haemoglobin is correct. level Epoetin alfa is a medication used to stimulate the production of red blood cells in the bone marrow, and it is often prescribed to treat anaemia. Anaemia is characterized by a decrease in the number of red blood cells or a decrease in the amount of haemoglobin, which is responsible for carrying oxygen in the blood.

The therapeutic response to epoetin alfa is an increase in the haemoglobin level. This indicates that the medication is effectively stimulating the production of red blood cells, leading to an improvement in the client's anaemia and overall oxygen-carrying capacity of the blood.

Choice B reason:

Increased platelet count: Platelets are involved in blood clotting and are not directly affected by epoetin alfa.

Choice C reason:

Increased neutrophil count: Neutrophils are a type of white blood cell involved in the body's immune response. Epoetin alfa primarily affects red blood cells and does not directly impact white blood cell levels.

Choice D reason:

Increased erythrocyte sedimentation rate (ESR): ESR is a non-specific indicator of inflammation in the body and is not directly related to the therapeutic response of epoetin alfa in treating anaemia.

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A nurse is caring for a client who is 2 days postoperative following a total bilateralmastectomy. The client is tearful and looks away when her surgical dressings are removed. The nurse should place the priority on which of the following actions?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is updating the plan of care for a client who has amyotrophic lateral sclerosis with dysphagia. Which of the following interprofessional team members should the nurse identify as the priority to consult?

Correct Answer is C

Explanation

A nurse is evaluating the laboratory values of a client who is receiving epoetin alfa. Which of the following findings indicates a therapeutic response to the medication?

Correct Answer is A

Explanation

A nurse is preparing to complete a sterile dressing change for a client's wound. Which of the following actions should the nurse take first?

A nurse and an assistive personnel (AP) are repositioning a client who is immobile up in bed using a draw sheet. The nurse should instruct the AP to take which of the following actions?

A community health nurse is assisting with the development of a pamphlet regarding choking hazards for toddlers. Which of the following foods should the nurse include?

A nurse is contributing to an in-service for newly licensed nurses about situations requiring an incident report. Which of the following examples should the nurse include?

A nurse is planning care for a client who recently attempted suicide. Which of the following actions should the nurse plan to take?

A nurse is assisting with the admission of a client who has varicella zoster. Which of the following interventions should the nurse plan to implement?

A nurse is talking with a client who refuses a blood transfusion for religious reasons. Which of the following responses should the nurse make?

A school nurse is performing scoliosis screenings. The nurse should recognize which of the following clinical manifestations as an indication of scoliosis?