A nurse is assisting in creating a plan to reduce environmental stressors for clients in an acute care unit.
Which of the following actions should the nurse include in the plan?
Offer the clients many choices regarding care.
Restrict the number of visitors for clients.
Assign different nurses to provide care for clients each day.
Turn on loud music in client care areas.
The Correct Answer is B
This action can help to reduce environmental stressors for clients in an acute care unit by limiting noise, crowding, and potential sources of infection.
Visitors should be allowed according to the client’s preference and condition, but excessive or inappropriate visitors should be discouraged.
Choice A is wrong because offering the clients many choices regarding care can increase their stress and anxiety, especially if they are confused, overwhelmed, or unable to make decisions.
The nurse should respect the client’s autonomy and preferences, but also provide guidance and education to help them make informed choices.
Choice C is wrong because assigning different nurses to provide care for clients each day can reduce the continuity and quality of care, as well as the trust and rapport between the client and the nurse.
The nurse should strive to provide consistent and individualized care for each client and establish a therapeutic relationship.
Choice D is wrong because turning on loud music in client care areas can increase environmental stressors for clients in an acute care unit by creating noise pollution, disrupting sleep, and interfering with communication.
The nurse should maintain a quiet and calm environment for the clients and use music only if it is soothing and requested by the client.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
The correct answer is choice A. Use a communication board to interact with the client.
A communication board is a tool that allows the client to point to words, pictures, or symbols that express their needs, feelings, or pain level.
This is an effective way to communicate with a client who speaks a different language than the nurse and is unable to verbalize their pain.
Choice B is wrong because an assistive personnel who speaks the same language as the client is not a qualified interpreter and may not be able to convey the client’s pain accurately or maintain confidentiality.
Choice C is wrong because the FLACC scale is a measurement used to assess pain for children between the ages of 2 months and 7 years or individuals that are unable to communicate their pain.
It is not appropriate for a client who is 6 hours postoperative and can communicate their pain using a communication board.
Choice D is wrong because the FACES pain scale is a self-report measure of pain intensity developed for children.
It uses facial expressions to rate the severity of pain in children from 0-103.
It is not suitable for a client who speaks a different language than the nurse and may not understand the meaning of the faces.
Correct Answer is D
Explanation
The correct answer is choice D. A living will can specify which medical procedures a person wants or does not want to receive in certain situations, such as when they are terminally ill or permanently unconscious.
A living will is a type of advance directive, which is a legal document that provides instructions for medical care if a person is unable to make decisions for themselves.
Choice A is wrong because a person does not need to have advance directives in order to refuse recommended treatment.
They have the right to accept or decline any medical intervention at any time, as long as they are competent and able to communicate their wishes.
Choice B is wrong because a person does not need an attorney to name a designee in their health care proxy.
A health care proxy is another type of advance directive that appoints a person to make health care decisions for someone else if they are unable to do so.
A health care proxy can be completed without involving a lawyer, as long as it meets the state’s requirements for a valid document.
Choice C is wrong because a living will cannot be an oral statement that a person agrees upon with their provider.
A living will must be in writing and follow the state’s laws for creating legal documents.
Depending on the state, a living will may need to be signed by a witness or notarized.
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