Question

1. A nurse in a surgical clinic is providing teaching to a client who is scheduled for a modified radical mastectomy. Which of the following statements by a client indicates an understanding of the teaching?

1. “I can begin to drive 24 hours after surgery.”
2. “I will have my drains removed 1 hour prior to going home”.
3. “I will completer my arm exercises for time a day.”
4. “I can shower within 48 hours of my surgery.”

Answer 1

Answer: The correct answer is Option c. I will complete my arm exercises for time a day.

Explanation:

Arm exercises are encouraged following modified radical mastectomy to prevent lymphedema. Isotonic arm exercises help in:

• Preventing obstruction of lymph vessels or nodes which in turn prevents swelling.
• Preventing contractures and shortening of muscles
• Maintaining tone of the muscles
• Promoting blood circulation

Thus, when the patient says that she will complete her arm exercises everyday, it indicates proper understanding of the nursing instructions. Hence, the correct answer is Option c.

Why the other options are incorrect?

• Following modified radical mastectomy, numbness occurs in the arm of the operated side. Additionally drainage tubes at the operated side may be kinked while driving. So, patient teaching instructions to the patient shall include not to drive after surgery atleast until the drain is removed. Hence, option a is incorrect as the patient poorly understood about the surgery
• Drains (example, Jackson - Prat drain) are placed under the skin following modified mastectomy to drain the fluid collected at operated site and promote healing. These are usually removed one to three weeks (but not 1 hour before going home) following surgery when the drain is less than 25 mL per day. Hence, option b is incorrect as the patient did not understand about removal of drainage tubes.
• “I can shower within 48 hours of my surgery.” Taking shower following modified radical mastectomy is allowed only after removal of drainage tubes i.e 1 to 3 weeks following surgery. As the statement by patient is contradictory to this teaching which will lead to infection, option d is also incorrect.