A nurse is assisting with the care of a client who has a recent diagnosis of a chronic condition and is exhibiting findings of ineffective coping. Which of the following actions should the nurse take first?
Determine if the client has a support system.
Schedule a mental health consult for the client.
Provide the client with information about coping strategies.
Encourage the client to attend a support group.
The Correct Answer is A
A) Determine if the client has a support system. - Assessing the client's current support network is essential to determine available resources and potential interventions.
B) Schedule a mental health consult for the client. - While mental health support may be necessary, understanding the client's existing support system is the first step.
C) Provide the client with information about coping strategies. - Providing coping strategies is important but should come after assessing the client's support system.
D) Encourage the client to attend a support group. - Encouraging attendance at support groups can be helpful, but it's important to assess the client's current support system first.
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Related Questions
Correct Answer is B
Explanation
A. "I will gently restrain him during seizures."- Restraint during seizures can cause injury and is not recommended.
B. "I will loosen his clothing during seizures."- Loosening tight clothing helps prevent injury and ensures adequate ventilation during a seizure.
C. "I will insert a washcloth in his mouth during seizures."- Inserting objects into the mouth during a seizure can cause injury or obstruct the airway.
D. "I will turn him on his back during seizures."- Placing the client on their back during a seizure can increase the risk of aspiration. The recovery position is preferred
Correct Answer is B
Explanation
A. The nurse should stand on the client’s weaker side (left side) to provide support and stability during the transfer. Standing on the stronger side offers less assistance and increases the risk of falls.
B. When assisting a client with left-sided weakness to transfer from bed to chair, the nurse should use proper body mechanics to protect both the client and self.Flexing the hips and knees allows the nurse to use the leg muscles (strongest muscles) rather than the back, reducing risk of injury. This position also provides stability and balance, allowing controlled movement as the client stands.
C. Raise the bed to waist level before moving the client- Adjusting the bed height can facilitate the transfer process, but it is not directly related to the client's left-sided weakness.
D. Pivot on the foot farthest from the bed when assisting the client into the chair- Pivoting on the foot farthest from the bed allows for a smooth and controlled transfer motion but does not address the client's left-sided weakness specifically.
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