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 C
Explanation
Choice A Reason:
Turning the hearing aid off for 5 min is inappropriate. Turning off the hearing aid may not address the underlying issue of feedback. Adjusting the volume or checking for proper placement is more appropriate.
Choice B Reason:
Cleaning the hearing aid with isopropyl alcohol is inappropriate. While cleaning the hearing aid is important for maintenance, using isopropyl alcohol may damage certain components. It's generally recommended to use a specialized cleaning solution recommended by the hearing aid manufacturer.
Choice C Reason:
Decreasing the volume on the hearing aid is appropriate. The whistling sound, also known as feedback, can occur when the volume is set too high. Lowering the volume should help alleviate the feedback and improve the client's experience with the hearing aid.
D. Soak the hearing aid in warm water.
Soaking a hearing aid in water is not recommended, as it can damage the electronic components. Hearing aids are sensitive to moisture, and water exposure can lead to malfunction.
Correct Answer is C
Explanation
Choice A Reason:
Avoid entering the client's room unless requested during the night is inappropriate. While minimizing entries can reduce disruptions, it's important for the nurse to perform necessary checks and care interventions. Avoiding the room completely might compromise the client's safety or care.
Choice B Reason:
Turn off alarms on bedside monitoring equipment is inappropriate. Disabling alarms can jeopardize patient safety as these alarms often indicate critical changes in the client's condition. Adjusting alarm settings or investigating if noise levels can be reduced without compromising safety would be more appropriate.
Choice C Reason:
Conduct staff communications away from the client's room is appropriate. This intervention helps minimize noise levels near the client's room, creating a quieter environment conducive to sleep. Staff conducting communications away from the room reduces unnecessary disturbances that might affect the client's rest.
Choice D Reason:
Turn on the client's TV to distract from hallway noise is inappropriate. Introducing more noise, such as from a TV, might not effectively address the issue of sleep disturbance due to external noise. Additionally, it's essential to respect the client's preferences, and some may prefer a quiet environment for sleep rather than additional noise from a TV.
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