A nurse is providing discharge teaching to a client following a modified left mastectomy. Which statements by the client indicate an understanding of the teaching?

"I will keep my left arm flexed at the elbow as much as possible."

"I will have to wait 2 months before additional saline can be added to my breast expander."

"should expect less than 25 mL of secretions per day in the drainage devices."

"I will perform strength-building arm exercises using a 15-pound weight."

Answer and Explanation

The Correct Answer is B

Choice A reason:

"will keep my left arm flexed at the elbow as much as possible": This statement is incorrect because after a mastectomy, it's important to promote full range of motion in the affected arm to prevent complications like contractures and lymphedema.

Choice B reason:

“will have to wait 2 months before additional saline can be added to my breast expander" This is the correct statement. Following a modified radical mastectomy with a breast expander, additional saline is often added gradually to the expander to stretch the skin and muscle for reconstruction. The waiting period between saline additions allows for healing and proper tissue expansion. This statement indicates that the client understands the postoperative care and timeline.

Choice C reason:

"should expect less than 25 ml of secretions per day in the drainage devices": This statement is not accurate because the drainage amount can vary, and 25 ml per day might not be an accurate estimate.

Choice D reason:

"will perform strength-building arm exercises using a 15-pound weight": This statement is not appropriate, especially shortly after surgery. Gradual and gentle strength-building exercises are recommended, and using a 15-pound weight could be too strenuous and potentially harmful.

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Correct Answer is A

Explanation

Choice A reason:

Complete AV block with rates slower than 40/min Complete atrioventricular (AV) block, especially with rates slower than 40 beats per minute (bradycardia), is an indication for the placement of a permanent pacemaker. Complete AV block means there is a complete block in the electrical conduction between the atria and ventricles, resulting in a significant slowing or absence of impulses reaching the ventricles. This can lead to dangerously low heart rates and inadequate cardiac output.

Choice B reason:

Vasovagal bradycardia without syncope - Vasovagal bradycardia is often a temporary response to certain triggers (like pain or emotional stress) and does not typically require a permanent pacemaker.

Choice C reason:

Sinus tachycardia with rates faster than 80/min - Sinus tachycardia is a normal response to various factors, such as exercise, fever, or anxiety. It's not an indication for a permanent pacemaker.

Choice D reason:

Asymptomatic second-degree AV block - Asymptomatic second-degree AV block can be monitored and managed without a pacemaker, especially if the patient is not experiencing any symptoms or hemodynamic compromise. However, the type and severity of the second-degree AV block should be assessed by a healthcare provider to determine the appropriate course of action

A. Disequilibrium with movement B. Deviation of the tongue from midline C. Loss of peripheral vision D. mobility to smell

Correct Answer is A

Explanation

Choice A reason:

Disequilibrium with movement is correct. The vestibulocochlear nerve (cranial nerve VIII) is responsible for both hearing (cochlear component) and balance (vestibular component). Impaired function of this nerve can result in problems with equilibrium and balance, leading to symptoms such as disequilibrium or vertigo (a sensation of spinning or whirling), especially with movement.

Choice B Reason:

Deviation of the tongue from midline is incorrect. This is related to cranial nerve XII (hypoglossal nerve) and its role in tongue movement and control.

Choice C Reason:

Loss of peripheral vision is incorrect. This is related to cranial nerve II (optic nerve) and its role in vision.

Choice D Reason:

Inability to smell is incorrect. This is related to cranial nerve I (olfactory nerve) and its role in the sense of smell.

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A nurse is providing discharge teaching to a client following a modified left mastectomy. Which statements by the client indicate an understanding of the teaching?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is reviewing a client's cardiac monitor for dysrhythmias. Which of the following findings should the nurse identify as an indication for the placement of a permanent pacemaker?

Correct Answer is A

Explanation

A nurse is performing a cranial nerve assessment on a client following a head injury. Which of the following findings should the nurse expect if the client has impaired function of the vestibulocochlear nerve (cranial nerve VIII)?

Correct Answer is A

Explanation

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