A nurse is providing postoperative care for a client who has undergone a right radical mastectomy. Which action should the nurse take to prevent lymphedema development?
Keep both arms below the client’s heart level.
Avoid range-of-motion exercises with the affected arm.
Use the client’s left arm to draw blood samples.
Obtain blood pressure readings using the client’s right arm.
The Correct Answer is C
Choice C.
Choice A rationale
Keeping both arms below the heart level can actually increase the risk of lymphedema development. This position can lead to pooling of lymphatic fluid in the arm, which can exacerbate swelling.
Choice B rationale
Avoiding range-of-motion exercises with the affected arm is not recommended. Regular gentle exercises can help promote lymphatic drainage and prevent lymphedema.
Choice C rationale
Using the client’s left arm (the non-operated arm) to draw blood samples is a recommended practice. This reduces the risk of infection and injury to the right arm, which could potentially trigger or worsen lymphedema.
Choice D rationale
Obtaining blood pressure readings using the client’s right arm (the operated arm) is not recommended. The pressure exerted by the blood pressure cuff can obstruct lymphatic flow and contribute to lymphedema.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Elevating the legs on pillows when in bed is not typically recommended for patients with peripheral arterial disease (PAD). This position can actually decrease arterial blood flow to the legs and worsen symptoms.
Choice B rationale
Applying a heating pad for 15 minutes twice per day is not a standard recommendation for managing PAD. While heat can increase blood flow, it can also lead to burns in patients with decreased sensation due to PAD1.
Choice C rationale
Beginning an exercise program that includes walking is often recommended for patients with PAD. Regular physical activity can improve symptoms of claudication (pain caused by reduced blood flow) and increase overall cardiovascular health.
Choice D rationale
Wearing knee-high support hose during the day is not typically recommended for patients with PAD. Compression stockings are more often used in the management of venous rather than arterial conditions.
Correct Answer is C
Explanation
Choice A rationale
Bathing in a tub until the catheter is removed is not recommended after a transurethral resection of the prostate (TURP). This could increase the risk of infection.
Choice B rationale
Taking ibuprofen for discomfort is not typically recommended after TURP. Ibuprofen can increase the risk of bleeding.
Choice C rationale
Waiting 6 weeks before resuming sexual intercourse is a standard recommendation after TURP. This allows the body time to heal.
Choice D rationale
Driving after 1 week is not typically recommended after TURP. Patients are usually advised to avoid driving until they are free of pain and can move quickly and safely.
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