Difficulty: Medium
Average Score: 79%
Simulated
A nurse is caring for a client following a bilateral mastectomy. The client is often tearful and avoids looking at her dressings. Which of the following actions should the nurse take first?
Correct answer
B
Rationale
The correct answer is B: Identify the impact of the mastectomy on the client's body image. The first step is to assess the client's emotional state and address her feelings of sadness and avoidance, which are indications of body image issues. By identifying the impact of the mastectomy on body image, the nurse can provide appropriate emotional support and interventions. Referring the client to a support group (A) can be helpful but should come after understanding the client's individual needs. Encouraging the client to assist with dressing changes (C) may not address the underlying emotional distress. Providing a mirror (D) may worsen the client's distress if she is not ready to confront her incisions.