A male client who has just been told he has cancer asks the practical nurse (PN) to leave his room so he can be alone. Which action should the PN implement?
Consult with the charge nurse about implementing suicide precautions.
Sit quietly in the client's room until the client is ready to verbalize his feelings.
Leave the room after offering to return to the client's room at a later time.
Notify a member of the client's family of the need to come to stay with the client.
The Correct Answer is C
The correct answer is choice C: Leave the room after offering to return to the client's room at a later time.
Choice A rationale:
Consulting with the charge nurse about implementing suicide precautions is not appropriate in this situation. The client has not expressed suicidal ideation or intent, and such an action could be invasive and distressing for the client.
Choice B rationale:
Sitting quietly in the client's room until the client is ready to verbalize his feelings might seem supportive, but it disregards the client's request for alone time. It's essential to respect the client's wishes and provide an opportunity for self-reflection and privacy.
Choice C rationale:
Leaving the room after offering to return to the client's room at a later time is the most appropriate action. The client has requested solitude, and respecting his autonomy is crucial in building trust and rapport.
Choice D rationale:
Notifying a member of the client's family of the need to come stay with the client is not necessary at this point. The client's desire for alone time does not indicate an immediate need for family support. The practical nurse should first respect the client's request and give him space to process the news. If the client later expresses a need for family support, appropriate actions can be taken accordingly.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
The correct answer is **b. Oral feeding of a two-year-old child after application of a hip spica cast.**
Choice A rationale:
Participation in staff rounds to record notes regarding client goals is not an appropriate task to delegate to a UAP. This task requires clinical assessment, judgment, and documentation skills that are within the scope of practice of a licensed practical nurse (PN), but not a UAP.
Choice B rationale:
Oral feeding of a two-year-old child after application of a hip spica cast is an appropriate task that the PN can delegate to a UAP. Feeding a stable patient is a routine task that does not require advanced nursing skills or clinical judgment. As long as the child is not at high risk for complications, this task can be safely delegated to a UAP with proper training and supervision.
Choice C rationale:
Evaluation of a client's incisional pain following narcotic administration is not an appropriate task to delegate to a UAP. This task requires clinical assessment, evaluation of medication effects, and critical thinking skills that are within the scope of practice of a PN, but not a UAP.
Choice D rationale:
Assessment of the placement and patency of a nasogastric feeding tube is not an appropriate task to delegate to a UAP. This task requires specialized nursing skills and clinical judgment to ensure the safety and effectiveness of the feeding tube. It is within the scope of practice of a PN, but not a UAP.
Correct Answer is A
Explanation
A thready pulse is a weak and rapid pulse that is easily obliterated by light pressure. It indicates poor blood flow and perfusion, and may be caused by conditions such as shock, dehydration, or hemorrhage.
The other options are not correct because:
- A missing pulse is a pulse that is absent or cannot be detected, even with firm pressure. It indicates a complete blockage of blood flow, and may be caused by conditions such as arterial occlusion, embolism, or trauma.
- Light pressure applied to pulse is not a documentation of the pulse quality, but a description of the technique used to palpate the pulse.
- Pulse skips beats is a documentation of an irregular pulse rhythm, not a pulse volume. It indicates that the heart beats are unevenly spaced, and may be caused by conditions such as arrhythmia, stress, or caffeine intake.
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