A nurse is assessing a client.
Which of the following factors should the nurse consider?
The client speaks another language.
The client has decreased vision but is wearing glasses.
The client has hearing loss, but hearing aids are functioning well.
The client’s culture.
The Correct Answer is D
Choice A rationale
The client speaking another language is an important factor to consider, but it is not the most comprehensive factor. Language barriers can affect communication and understanding, but they can be addressed with interpreters and translation services. Considering the client’s culture encompasses language and other cultural aspects that influence healthcare.
Choice B rationale
The client having decreased vision but wearing glasses is a specific factor related to sensory perception. While it is important to consider, it does not encompass the broader cultural context that can impact healthcare. Addressing vision issues is part of a comprehensive assessment, but culture provides a more holistic understanding.
Choice C rationale
The client having hearing loss but functioning hearing aids is another specific factor related to sensory perception. It is important to consider for effective communication, but it does not provide a comprehensive understanding of the client’s cultural background and its impact on healthcare.
Choice D rationale
The client’s culture is the most comprehensive factor to consider. Culture influences health beliefs, practices, communication styles, and decision-making. Understanding the client’s cultural background helps the nurse provide culturally competent care, build trust, and address any potential cultural barriers to healthcare.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Providing the instructions in an audio format is a suitable solution for clients who are unable to read. It ensures they can understand and follow the medication instructions accurately.
Choice B rationale
Ensuring the client has someone to assist with reading the instructions is helpful but not always reliable. The client may not always have someone available to assist them.
Choice C rationale
Using larger print for the instructions can help, but it may not be sufficient for clients with severe visual impairments.
Choice D rationale
Teaching the client to use a magnifying glass is a practical solution, but it may not be as effective as providing audio instructions, especially if the client has difficulty using the magnifying glass.
Correct Answer is B
Explanation
Choice A rationale
Feeding a stroke client who has difficulty in swallowing is a task that requires careful attention to prevent aspiration and choking. While this task is important, it can be delegated to a trained nursing assistant or a licensed practical nurse (LPN) under the supervision of an RN. The RN should focus on tasks that require higher levels of clinical judgment and expertise.
Choice B rationale
Completing a sterile dressing change to a pressure ulcer is a task that requires the expertise and clinical judgment of an RN. Sterile dressing changes involve maintaining a sterile field, assessing the wound, and applying appropriate dressings. This task is critical for preventing infection and promoting wound healing, making it appropriate for the RN to perform.
Choice C rationale
Reapplying a condom catheter for a client with urinary incontinence is a routine procedure that can be delegated to a trained nursing assistant or an LPN. This task does not require the advanced clinical skills and judgment of an RN, allowing the RN to focus on more complex and critical tasks.
Choice D rationale
Reinforcing teaching with a client who is learning how to administer insulin is an important task, but it can be delegated to an LPN under the supervision of an RN. The RN should prioritize tasks that require higher levels of clinical expertise and judgment, such as sterile dressing changes and complex assessments.
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