A nurse is caring for a client who has acute lymphocytic leukemia. The client is refusing blood products. Which one of the following responses should the nurse take?
“I understand that you decided not to receive blood products.”
“Not receiving blood will slow down your memory”
“Why are you refusing to receive blood products?”
“You need to talk with your doctor about this”
The Correct Answer is A
Choice A Reason:
“I understand that you decided not to receive blood products.” This response shows empathy and acknowledges the client's decision without judgment. It respects the client's autonomy and decision-making capacity.
Choice B Reason:
“Not receiving blood will slow down your memory.” This statement introduces a potential consequence that may not be accurate or relevant to the client's decision. It is important to provide information, but scare tactics or inaccurate statements may not be helpful.
Choice C Reason:
“Why are you refusing to receive blood products?” While understanding the client's rationale is essential, the initial response should convey empathy and acceptance. Asking why may be appropriate later in the conversation, but starting with understanding is crucial.
Choice D Reason:
“You need to talk with your doctor about this.” While involving the doctor is important, it's essential to address the client's feelings and decisions directly. The nurse can play a supportive role in facilitating communication between the client and the healthcare team.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A Reason:
Increase in fluid requirements is incorrect. An increase in fluid requirements is more likely to contribute to changes in fluid balance and not necessarily to long-term weight gain. While short-term fluctuations in fluid retention can affect weight, sustained weight gain is not typically attributed to increased fluid intake.
Choice B Reason:
Decrease in vitamin intake is incorrect. While inadequate vitamin intake can have various health implications, direct weight gain is not a typical outcome. However, a poor diet that lacks essential nutrients, including vitamins, can lead to overall health issues, potentially influencing weight management indirectly.
Choice C Reason:
Increase in protein requirements is incorrect. An increase in protein requirements, in itself, is not likely to result in weight gain. However, a diet with an excess of calories, including proteins, can contribute to weight gain. It's essential to consider the overall dietary balance and caloric intake.
Choice D Reason:
Decrease in muscle mass is correct. Decrease in muscle mass, known as sarcopenia, is a common age-related change. As muscle mass decreases, there can be a reduction in metabolic rate, potentially leading to weight gain. Additionally, the loss of muscle may be accompanied by an increase in fat mass, contributing to changes in overall body composition.
Correct Answer is A
Explanation
Choice A Reason:
"I should advance my crutches up the step ahead of my unaffected leg." This statement demonstrates correct technique for ascending stairs with crutches. When going up stairs, the client should advance the crutches onto the step first, followed by the unaffected leg.
Choice B Reason:
"I should keep my elbows straight when I am walking with my crutches." The client should maintain a slight bend in the elbows while walking with crutches to provide stability and support.
Choice C Reason:
"I will support my weight on the hand grips of the crutches." The client should not support their weight on the hand grips alone; weight should be distributed through the hands and arms to avoid putting excessive pressure on the axillae.
Choice D Reason:
"When I'm walking around my house with my crutches, it's okay to take my shoes off." It is generally not advisable to walk with crutches without shoes, as wearing shoes provides better support and stability. The client should wear supportive, non-skid footwear while using crutches.
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