A nurse is caring for a client who has impaired speech.
Which of the following actions should the nurse take?
Allow extra time to communicate with the client.
Finish sentences for the client.
Avoid using visual aids for communication.
Ask open-ended questions.
The Correct Answer is A
Choice A rationale:
Allowing extra time to communicate with the client is a crucial action when caring for a client with impaired speech. This approach respects the client's autonomy and ensures that they have the time they need to express themselves. It is an appropriate and compassionate response to the client's condition.
Choice B rationale:
Finishing sentences for the client is not recommended because it interferes with the client's ability to communicate independently. It does not respect the client's autonomy and may lead to frustration.
Choice C rationale:
Avoiding the use of visual aids for communication is not a best practice, especially for clients with impaired speech. Visual aids can enhance communication and should be used when appropriate.
Choice D rationale:
Asking open-ended questions is a good communication strategy, but it is not the first action to take. Allowing extra time for communication should be the initial step when caring for a client with impaired speech.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale:
Full thickness skin loss with visible bone. This choice does not align with the description of a stage 2 pressure injury. Stage 2 pressure injuries are characterized by partial-thickness skin loss, but they do not involve visible bone. This description corresponds to a more severe stage of pressure injury.
Choice B rationale:
Intact skin with localized erythema. This choice describes a normal skin condition with localized redness (erythema) but does not indicate the presence of a pressure injury. Stage 2 pressure injuries involve partial-thickness skin loss, which means there is a break in the skin integrity.
Choice C rationale:
Full thickness skin loss with visible adipose tissue. This description is more in line with a stage 3 pressure injury, not a stage 2 injury. In stage 3, there is full-thickness skin loss, and adipose tissue may become visible in the wound bed. However, in stage 2, the skin loss is partial-thickness, and the wound bed typically contains red tissue.
Choice D rationale:
Partial-thickness skin loss with red tissue in the wound bed. This choice is the correct description of a stage 2 pressure injury. Stage 2 pressure injuries involve partial-thickness skin loss with the presence of red or pink tissue in the wound bed. It signifies damage to the epidermis and possibly the dermis. .
Correct Answer is A
Explanation
Choice A rationale:
Role performance. Role performance is a self-concept stressor that occurs when individuals struggle to meet their responsibilities and expectations in various roles, such as work, family, or social roles. In this scenario, the client is feeling stressed due to the demands of work and caring for an ill family member, indicating a struggle with their roles and responsibilities.
Choice B rationale:
Body image. Body image relates to how individuals perceive and feel about their physical appearance. It is not the primary self-concept stressor described in this situation. While stressors related to body image can cause psychological distress, the client's stress is primarily linked to their roles and responsibilities.
Choice C rationale:
Self-esteem. Self-esteem refers to an individual's overall self-worth and self-evaluation. While it can contribute to stress in various situations, the client's stress in this case is more directly related to their role performance and responsibilities.
Choice D rationale:
Identity. Identity concerns are related to an individual's sense of self and how they define themselves in terms of their values, beliefs, and personal characteristics. While identity can be a source of stress in some cases, the client's reported stress is primarily due to their inability to manage their roles effectively.
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