A nurse is caring for a client who has a new diagnosis of diabetes mellitus and is refusing to learn how to self-administer insulin. Which of the following responses should the nurse make?
“I’d like to hear your thoughts about giving yourself this medication.”
"You will suffer serious health issues if you don't take your medication."
"Why don't you want to learn how to give yourself your medication?"
“Have you considered how your decision to refuse medication will affect your family?"
The Correct Answer is A
A. “I’d like to hear your thoughts about giving yourself this medication.”: This response uses open-ended, therapeutic communication that invites the client to express concerns, fears, or misconceptions. It demonstrates respect for autonomy and helps build trust while allowing the nurse to assess readiness to learn. Understanding the client’s perspective is essential before providing education or problem-solving.
B. “You will suffer serious health issues if you don't take your medication.”: This response uses fear and threats, which can increase anxiety and resistance rather than promote cooperation. It does not encourage dialogue or address the client’s underlying concerns.
C. “Why don't you want to learn how to give yourself your medication?”: Questions beginning with “why” can feel accusatory or judgmental, causing the client to become defensive. Although the nurse needs to understand the client’s reluctance, this phrasing may inhibit open communication. A more neutral approach is preferred.
D. “Have you considered how your decision to refuse medication will affect your family?”: This response applies guilt and shifts the focus away from the client’s feelings and autonomy. It does not promote therapeutic communication or support informed decision-making. Using guilt can undermine trust and collaboration.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Reviewing the results of the client's urinalysis with their parents, without the client's consent: Routine urinalysis results are generally considered part of standard adolescent care and may be shared with parents depending on the clinic policy and state laws, so this may not necessarily breach confidentiality.
B. Reviewing the results of the client's celiac screening with their parents, without the client's consent: Celiac screening is part of general health testing and usually does not fall under sensitive health information; sharing these results with parents is typically permissible in pediatric care.
C. Reviewing the results of the client's complete blood count (CBC) with their parents, without the client's consent: A CBC is standard lab work and does not usually involve sensitive information, so sharing results with parents is generally acceptable and not considered a breach of confidentiality.
D. Reviewing the results of the client's chlamydia screening with their parents, without the client's consent: STI testing is considered confidential for adolescents, and sharing these results without consent violates privacy laws and ethical guidelines. Protecting confidentiality encourages adolescents to seek care and be honest about sexual health.
Correct Answer is A
Explanation
A. An assistive personnel is encouraging intake of oral fluids: For a client in the active dying phase, forcing or encouraging oral intake can cause discomfort, aspiration, or fluid overload. The focus should be on comfort rather than meeting standard hydration goals, so this requires intervention by the nurse.
B. Supplemental oxygen is in use: Oxygen may be provided for comfort if the client experiences dyspnea. Its use in the active dying phase is appropriate and does not require intervention unless it causes discomfort or is unnecessary.
C. Benzodiazepines are administered every 4 hr: Scheduled benzodiazepines can help manage anxiety, restlessness, or dyspnea in a dying client. This is an appropriate intervention for comfort and does not require nurse intervention.
D. A family member remains at the client's bedside 24 hr each day: Continuous presence of family provides emotional support and comfort for both the client and loved ones. This is consistent with hospice care principles and does not require nurse intervention.
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