Nursing 211

N211: Health Differences Across the Lifespan I

72. The most appropriate nursing diagnosis for immediate care of a patient who has undergoing a radical mastectomy would be: a. high risk for sexual dysfunction related to altered self-image as a result of loss of female body part. b. body image disturbance related to loss of female body part. c. inability to perform self-care related to partial immobility. d. potential for self-esteem disturbance related to altered body image. 73. The most common position for a patient following a radical mastectomy is: a. supine with both arms elevated on pillows. b. on the affected side with pillows between the knees. c. semi-Fowlers position with the hand on the affected side kept elevated above the elbow. d. On the unaffected side with the affected arm elevated on pillows. 74. The swelling that frequently occurs after a radical mastectomy is usually the result of: a. hypervolemia b. decreased perfusion to the extremities c. interruption of lymphatic vessels d. immobility

75. Evidence that a patient with a new colostomy is ready to start taking part in self-care would be: a. looking at and touching her colostomy. b. practicing opening and closing the clamp on an empty bag. c. reading patient education literature about colostomy care. d. voluntarily watching a patient education video regarding colostomy care.

Answer Key on Page 143.

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