A nurse is caring for a client who has uterine prolapse. The provider has recommended a total abdominal hysterectomy, but the client tells the nurse that the surgery is not an option. Which of the following is an appropriate action for the nurse to take?
Respect the client's decision and inform the provider
Explain the benefits and risks of the procedure
Suggest alternative treatments for the condition
Assess the client's understanding of the consequences of uterine prolapse and the need for surgery
The Correct Answer is D
Choice A reason: Respecting the client's decision and informing the provider is an appropriate action, but not the first one that the nurse should take. The nurse should first assess the client's understanding of the condition and the treatment options, and provide education and support as needed.
Choice B reason: Explaining the benefits and risks of the procedure is an appropriate action, but not the first one that the nurse should take. The nurse should first assess the client's understanding of the condition and the treatment options, and provide education and support as needed.
Choice C reason: Suggesting alternative treatments for the condition is an appropriate action, but not the first one that the nurse should take. The nurse should first assess the client's understanding of the condition and the treatment options, and provide education and support as needed.
Choice D reason: Assessing the client's understanding of the consequences of uterine prolapse and the need for surgery is the first and most appropriate action that the nurse should take. The nurse should determine the client's knowledge, beliefs, and preferences regarding the condition and the surgery, and address any gaps, misconceptions, or concerns. The nurse should also respect the client's autonomy and right to make informed decisions about their health care.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason: Reminiscence therapy is a type of intervention that helps clients with Alzheimer's disease recall and share their past experiences, memories, and emotions. This can enhance their self-esteem, mood, and quality of life. By requesting a referral for this therapy, the nurse is advocating for the client's psychosocial needs and preferences.
Choice B reason: Performing an updated cognitive assessment on the client is not an example of advocacy, but rather a standard nursing practice. Cognitive assessments are used to monitor the client's cognitive status and progression of the disease. They do not necessarily reflect the client's wishes or interests.
Choice C reason: Providing assistance for the client when ambulating down the hall is not an example of advocacy, but rather a safety measure. The nurse is helping the client prevent falls and injuries, which are common risks for clients with Alzheimer's disease. This does not imply that the nurse is speaking up for the client or protecting their rights.
Choice D reason: Reorienting the client several times throughout the day is not an example of advocacy, but rather a therapeutic communication technique. The nurse is helping the client cope with confusion and disorientation, which are common symptoms of Alzheimer's disease. This does not indicate that the nurse is supporting the client's goals or values.
Correct Answer is ["A","B","C","E"]
Explanation
Choice A: Ambulate the client
Ambulating the client is a task that can be safely delegated to assistive personnel. The client has right-sided weakness following a cerebrovascular accident, and assistive personnel can help the client move around safely¹.
Choice B: Document the client's urine output
Documenting the client's urine output is another task that can be delegated to assistive personnel. They are trained to measure and record urine output, which is important for monitoring the client's fluid balance¹.
Choice C: Assist the client with completing their food menu
Assistive personnel can also help the client with completing their food menu. This task does not require clinical judgement and can be safely delegated¹.
Choice D: Instruct the client on swallowing techniques
Instructing the client on swallowing techniques should not be delegated to assistive personnel. This task requires specialized knowledge and skills that are beyond the scope of practice for assistive personnel².
Choice E: Obtain the client's vital signs
Obtaining the client's vital signs is a task that can be delegated to assistive personnel. They are trained to accurately measure and record vital signs, which are crucial for monitoring the client's health status¹.
Choice F: Refer the client to the speech language pathologist
Referring the client to the speech language pathologist is not a task that can be delegated to assistive personnel. This decision requires clinical judgement and should be made by the nurse².
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today