A nurse in a long-term care facility is planning to use therapeutic touch for a group of selected clients who have chronic pain. The nurse should identify that the use of therapeutic touch is contraindicated for which of the following clients?

A client who has chronic back pain and a history of physical maltreatment

A client who has chronic joint discomfort and a history of mild dementia

A client who has chronic knee pain and a history of grand mal seizures

A client who has chronic hip pain and a history of uterine cancer

Answer and Explanation

The Correct Answer is A

A. A client who has chronic back pain and a history of physical maltreatment: Therapeutic touch involves close physical proximity and intentional hand movements, which may trigger psychological distress or trauma responses in individuals with a history of maltreatment.

B. A client who has chronic joint discomfort and a history of mild dementia: Clients with mild dementia may still tolerate therapeutic touch well, as it can provide comfort and reduce agitation. With careful explanation and reassurance, this intervention can be beneficial.

C. A client who has chronic knee pain and a history of grand mal seizures: Therapeutic touch does not induce seizures, as it is a noninvasive energy-based practice. It does not increase seizure risk in clients with a seizure history.

D. A client who has chronic hip pain and a history of uterine cancer: Having a history of cancer is not a contraindication to therapeutic touch. This approach does not involve deep tissue manipulation and can be safely applied to provide comfort and pain relief.

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Correct Answer is C

Explanation

A. "I can leave my contact lenses in place during surgery.": Contact lenses must be removed before general anesthesia because they can cause corneal irritation or injury. Additionally, dry eyes during anesthesia increase the risk of corneal damage if lenses are left in place.

B. "I will pull my hair back with a hair clip before applying the surgical cap.": Hair clips and pins are not permitted in the operating room because they may pose a risk of injury, interfere with surgical positioning, or be a source of contamination under the cap.

C. "I should remove nail polish from my fingers before surgery.": Removing nail polish is essential because it allows accurate monitoring of oxygen saturation with a pulse oximeter. Nail polish can block or distort light transmission, leading to inaccurate readings.

D. "I can keep my eye makeup on during surgery.": Eye makeup should not be worn because particles can enter the eye during anesthesia and cause irritation or infection. Additionally, makeup can interfere with the sterile environment of the operating room.

A. Witnessing a client's signature for informed consent B. Instructing a client about how to apply antiembolic stockings C. Ensuring that all clients receive equal treatment D. Requesting a social services consultation for a client who states they cannot afford their medications

Correct Answer is D

Explanation

A. Witnessing a client's signature for informed consent: Witnessing consent is a legal responsibility, not an advocacy role. The nurse verifies the client’s signature but does not address the client’s needs or ensure their voice is represented in care decisions.

B. Instructing a client about how to apply antiembolic stockings: Teaching a client is part of health promotion and nursing education. While important, it does not represent advocacy since it does not involve speaking up or acting on behalf of the client’s expressed needs.

C. Ensuring that all clients receive equal treatment: Providing equitable care is an ethical obligation for all nurses but does not fully represent advocacy. Advocacy specifically involves acting on a client’s behalf when barriers or unmet needs are identified.

D. Requesting a social services consultation for a client who states they cannot afford their medications: This is advocacy because the nurse is acting on the client’s expressed concern and connecting them to resources that address barriers to care. It ensures the client’s health needs are supported beyond routine clinical interventions.

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A nurse in a long-term care facility is planning to use therapeutic touch for a group of selected clients who have chronic pain. The nurse should identify that the use of therapeutic touch is contraindicated for which of the following clients?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is evaluating preoperative teaching with a client who is to undergo surgery with general anesthesia. Which of the following statements by the client indicates an understanding of the teaching?

Correct Answer is C

Explanation

A charge nurse is providing an in-service about client advocacy to a group of newly licensed nurses. Which of the following examples should the nurse include?

Correct Answer is D

Explanation

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