Which activity should be restricted for a client following a transphenoidal hypophysectomy surgery?
Heavy lifting
Climbing stairs
Breathing exercises
Sexual intercourse
The Correct Answer is A
A. Heavy lifting. Activities that increase intrathoracic or intra-abdominal pressure can cause a spike in intracranial pressure, risking a cerebrospinal fluid leak at the surgical site. Straining can compromise the integrity of the nasal packing or the graft used to close the sella turcica. Clients must avoid lifting objects over 5 to 10 pounds for several weeks postoperatively to ensure proper healing.
B. Climbing stairs. Stair climbing is generally permitted as long as the client avoids overexertion and maintains a steady pace. It does not typically cause the significant increase in pressure associated with the Valsalva maneuver or heavy lifting. Patients are encouraged to ambulate slowly to prevent postoperative complications like deep vein thrombosis while remaining cautious of their balance.
C. Breathing exercises. Deep breathing and use of an incentive spirometer are encouraged to prevent atelectasis and pneumonia after surgery. However, the client is strictly taught to avoid coughing, sneezing, or blowing their nose, as these actions create high pressure in the nasal cavity. If a sneeze is unavoidable, the client should keep their mouth open to dissipate the pressure.
D. Sexual intercourse. While high-intensity physical exertion should be avoided, sexual activity is not specifically restricted unless it involves positions or straining that increase intracranial pressure. The primary focus of postoperative education is the avoidance of activities that directly stress the surgical site in the nasopharynx. Standard discharge instructions prioritize the prevention of straining over a total restriction of sexual activity.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Blood pressure control. Hypertension is both a common symptom and a primary driver of disease progression in polycystic kidney disease. Elevated systemic pressure accelerates cyst growth and glomerular damage, leading to a faster decline in renal function. Managing blood pressure, often with ACE inhibitors, is the most effective intervention to delay ESRD.
B. Fluid restriction. In the early to middle stages of PKD, fluid intake is actually encouraged to help suppress vasopressin, which can stimulate cyst growth. Strict fluid restrictions are generally reserved for patients who have already reached end-stage renal failure with oliguria. Early restriction is not a standard strategy for slowing the initial progression of cyst expansion.
C. Blood glucose control. While glycemic control is vital for diabetic nephropathy, it is not the primary mechanism for managing autosomal dominant polycystic kidney disease. PKD is a genetic structural disorder characterized by fluid-filled cysts rather than metabolic basement membrane thickening. Blood pressure management remains a more significant factor in preserving nephron longevity for these patients.
D. Pain management. Chronic pain from enlarging cysts and internal hemorrhage is a major quality-of-life issue for patients with PKD. However, while essential for comfort, analgesic administration does not physiologically slow the underlying biological progression of the disease or the decline in GFR. Blood pressure regulation directly addresses the vascular and structural stressors that destroy renal tissue.
Correct Answer is D
Explanation
A. "You are so young. Are you ready for the responsibilities of a sexual relationship?" This response is judgmental and dismissive, which can shut down communication and prevent the adolescent from seeking necessary healthcare. Nurses must maintain a neutral, non-judgmental stance to foster a safe environment for sensitive discussions. Questioning a client's maturity rather than providing information violates the principles of therapeutic communication.
B. "Before I can help you, I need to know more about your sexual activity." This approach may be perceived as intrusive and an interrogation rather than a helpful inquiry. While a sexual history is important, it should be collected within the context of a private clinical consultation rather than as a prerequisite for basic information. The nurse should focus on providing educational resources while respecting the client's privacy.
C. "Because of your age, I think that a barrier method would be the best choice." Recommending a specific method based on age alone is prescriptive and ignores the client’s individual needs and preferences. While barrier methods protect against STIs, they may not be the most effective for pregnancy prevention in adolescents. The nurse’s role is to educate on all options rather than making a unilateral decision for the client.
D. "A provider can help you with that after a physical examination." This response correctly directs the adolescent to a professional clinical setting where they can receive a comprehensive assessment and individualized counseling. It emphasizes that choosing a contraceptive method is a medical decision that requires a physical exam and a discussion of health history. This ensures the client receives the most safe and effective method for their specific health profile.
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