A nurse in an urgent care center is caring for a young adult client who requires suturing of a laceration. The client tells the nurse, "My family should have been here by now. I can't go through this without them." Which of the following responses should the nurse make?
"I'm sure your family will be here soon."
"I will be available for you until your family arrives."
"Why do you think your family is delayed?"
"You'll feel better once this procedure is over."
The Correct Answer is B
A. "I'm sure your family will be here soon.": While this response tries to reassure the client, it does not address the client’s current feelings or provide immediate support. It might also come across as dismissive since the nurse cannot be sure when the family will arrive.
B. "I will be available for you until your family arrives.": This response acknowledges the client’s anxiety and offers support in the meantime. It shows the nurse’s availability and commitment to making the client feel safe and supported while waiting for their family.
C. "Why do you think your family is delayed?": This question might make the client feel pressured or defensive and focuses on the delay rather than offering reassurance or emotional support. It does not directly address the client’s emotional needs.
D. "You'll feel better once this procedure is over.": While this response aims to reassure the client, it might minimize their current feelings of anxiety. It focuses on the future rather than addressing the immediate emotional needs of the client.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Herbal medicine: While herbal medicine may offer some benefits for relaxation or symptom management, it is not recommended immediately before surgery. Some herbs can interact with anesthesia or medications, and their effects are not always well understood.
B. Magnet therapy: Magnet therapy is a complementary therapy often used for pain management or to promote healing, but there is limited evidence to support its effectiveness for acute anxiety.
C. Guided imagery: Guided imagery helps reduce anxiety and promote relaxation. It involves imagining a calm and peaceful setting, which can help distract the mind and reduce pre-surgical stress. This method is safe and effective for managing anxiety.
D. Acupuncture: While acupuncture may be helpful for managing pain and stress, it requires specific knowledge and skill to perform. Acupuncture should not be performed immediately before surgery unless administered by a trained practitioner.
Correct Answer is ["A","C","D"]
Explanation
A. "Empty the ostomy pouch when it becomes one-third full of contents.": It is important to empty the ostomy pouch when it is about one-third full to prevent leakage and pressure on the stoma. This helps avoid skin irritation and maintain comfort.
B. "Expect the stoma to turn a purple-blue color as it heals.": A stoma should be a reddish-pink color. A purple or blue color indicates poor circulation and may signal complications such as ischemia, which requires immediate attention.
C. "Cut the opening of the pouch an inch larger than the stoma.": The opening of the ostomy pouch should be cut about one-quarter to one-half inch larger than the stoma to prevent irritation or pressure on the stoma. This ensures a good fit and reduces risk of skin damage.
D. "Place a piece of gauze over the stoma while changing the pouch.": Placing gauze over the stoma during pouch changes protects the skin around the stoma fromcontact with stooland absorbs any drainage.
E. "Use povidone-iodine to clean around the stoma.": Povidone-iodine is too harsh for cleaning the stoma area and may cause skin irritation. The recommended cleaning solution is warm water and mild soap, followed by proper drying, to avoid skin damage and infection.
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