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A community health nurse is conducting a home visit to assess an adult client with a chronic illness. Which of the following actions should the nurse prioritize to effectively evaluate the client's management of their chronic condition?

Assess the client's ability to perform activities of daily living (ADLs) and their impact on the client's overall health.

Review the client's current medication list and check for any missed doses.

Focus on the client's most recent laboratory results and compare them to past results.

Conduct a detailed family history to identify any genetic predispositions to the chronic illness.

Answer and Explanation

The Correct Answer is A

A. Assess the client's ability to perform activities of daily living (ADLs) and their impact on the client's overall health. ADL assessment provides crucial information about how well the client is managing their chronic illness and maintaining functional independence.

B. Review the client's current medication list and check for any missed doses. While this is important, it is a secondary concern compared to assessing functional status, which has a broader impact on health outcomes.

C. Focus on the client's most recent laboratory results and compare them to past results. Lab results are valuable but do not provide a comprehensive view of how the illness affects the client's daily life.

D. Conduct a detailed family history to identify any genetic predispositions to the chronic illness. Genetic predispositions are relevant for diagnosis and prevention but do not evaluate current management of the condition.

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Correct Answer is A

Explanation

A. Asking the client to rate the pain: Pain rating provides a subjective measure of the intervention’s effectiveness in reducing discomfort.

B. Having the client perform range-of-motion of the affected arm: This assessment is not specific to determining the effectiveness of cold therapy; it is more related to mobility or rehabilitation.

C. Monitoring the client's pulse rate: While pain can affect pulse rate, this is an indirect and nonspecific measure of pain or swelling reduction.

D. Inspecting the site for reduced swelling: Swelling reduction can be an indicator of decreased inflammation, but it does not provide a direct assessment of the client’s pain levels.

A. "I promise I won't tell anyone about this." B. "Your family is bad for doing this to you." C. "Let's discuss what happened with your family here." D. "It is not your fault that this happened."

Correct Answer is D

Explanation

A. "I promise I won't tell anyone about this." This is incorrect because nurses are mandated reporters and must report abuse to appropriate authorities. Promising confidentiality is misleading and violates legal obligations.

B. "Your family is bad for doing this to you." Making judgmental statements about the family can hinder the therapeutic relationship and may increase the child’s stress or feelings of loyalty conflict.

C. "Let's discuss what happened with your family here." Discussing abuse in the presence of the family may put the child at risk for retaliation and discourage open communication.

D. "It is not your fault that this happened." This statement reassures the child and helps mitigate feelings of guilt or shame that are common in abuse victims. It is supportive, nonjudgmental, and developmentally appropriate, fostering trust and safety.

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A community health nurse is conducting a home visit to assess an adult client with a chronic illness. Which of the following actions should the nurse prioritize to effectively evaluate the client's management of their chronic condition?

Nursing Test Bank

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