Question

a nurse is caring for a client who is postoperative following a modified radical mastectomy with axillary lymph node dissection. which of the following actions should the nurse take? select all that apply. a elevate the clients right arm on a pillow b take blood pressure readings on the clients right arm c begin exercises on the clients right arm one week after the procedure d have the client wear a sling on the right arm when ambulating e turn the client onto their left side when in bed

Explanation:

• Option A: Elevating the client's right arm on a pillow helps reduce edema by promoting lymphatic and venous return.
• Option B: Taking blood pressure readings on the client's right arm (the operative side) is contraindicated as it can increase the risk of lymphedema.
• Option C: Exercises should be started within 24 - 48 hours (not one week) post - procedure to prevent stiffness and promote range of motion.
• Option D: Wearing a sling can restrict movement and is not recommended as early movement is important for recovery.
• Option E: Turning the client onto their left side (non - operative side) when in bed helps prevent pressure on the surgical site and promotes comfort.

Answer:

A. Elevate the client's right arm on a pillow, E. Turn the client onto their left side when in bed