A nurse is teaching a group of teenage clients about the use of condoms for the prevention of sexually transmitted infections (STIs). Which of the following statements should the nurse include in the teaching?

Choice A reason:

While explaining discharge instructions is an important part of patient education and ensuring safety after leaving the hospital, it is not the immediate priority. The nurse must first address any potential medical issues that could compromise the patient's health, such as circulation and nerve function in the affected limb.

Choice B reason:

Applying an ice pack to the casted leg can help reduce swelling and provide comfort to the client. This is often recommended for the first 24 to 72 hours after the cast is applied, especially if the cast is on a leg. However, this is secondary to assessing the neurovascular status of the limb.

Choice C reason:

Performing a neurovascular assessment is the priority action for the nurse. This assessment includes checking for sensation, warmth, capillary refill, pulses, and movement. It is crucial to identify any signs of compromised blood flow or nerve injury early to prevent further complications.

Choice D reason:

Providing reassurance to the client and parents is important for emotional support and can help alleviate anxiety. However, the nurse's immediate priority is to ensure the physical well-being of the client, which includes performing a neurovascular assessment to detect any urgent issues.

The correct answer is: a, b, c, and e.

Choice A: “I will make sure to feel for changes in my underarm area.”

Reason: This statement is correct because the underarm area (axilla) contains lymph nodes that can be affected by breast cancer. Including the underarm area in a breast self-exam helps in detecting any unusual lumps or changes that could indicate a problem.

Choice B: “It is important to press firmly when feeling my breasts to detect changes.”

Reason: This statement is correct because using firm pressure during a breast self-exam helps to feel the deeper tissues of the breast, which is essential for detecting any abnormalities or lumps that might be present.

Choice C: “I don’t have to lie down to check my breasts. I can stand in the shower.”

Reason: This statement is correct because performing a breast self-exam in the shower is a common and effective method. The wet and slippery skin makes it easier to feel for any changes or lumps in the breast tissue.

Choice D: “If I feel a firm ridge in the lower curve of my breasts, I should report this immediately.”

Reason: This statement is incorrect because it is normal to feel a firm ridge in the lower curve of the breast. This ridge is part of the normal breast anatomy and does not necessarily indicate a problem.

Choice E: “Since I no longer have periods, I can perform an examination at any time of the month.”

Reason: This statement is correct because menopausal women do not have menstrual cycles to guide the timing of their breast self-exams. Therefore, they can choose any consistent day each month to perform the exam.