A nurse is caring for a client who is scheduled for a procedure, but the client states that they no longer want to undergo the procedure. Which of the following actions should the nurse take?

Explain that the treatment is both safe and therapeutic.

Tell the client that the procedure is necessary.

Notify the client's loved ones of the client's refusal of the procedure.

Inform the client they have the right to refuse treatment.

Answer and Explanation

The Correct Answer is D

A. Explain that the treatment is both safe and therapeutic: Providing reassurance about the safety and effectiveness of the procedure may be informative, but it can unintentionally pressure the client to consent. It does not respect the client’s autonomy or support their right to make independent healthcare decisions.

B. Tell the client that the procedure is necessary: Telling the client a procedure is necessary can sound coercive and may disregard their legal and ethical right to refuse treatment. Nurses must prioritize respecting the client's decisions, even if those decisions involve refusing recommended medical care.

C. Notify the client's loved ones of the client's refusal of the procedure: Informing family members without the client’s consent may breach confidentiality and is not appropriate unless the client is unable to make informed decisions. Client autonomy must be preserved, and their refusal should be respected unless there is an immediate risk of harm.

D. Inform the client they have the right to refuse treatment: Clients have the legal and ethical right to refuse any medical intervention, even if it is life-sustaining. The nurse’s role includes advocating for the client’s autonomy, ensuring informed consent, and supporting their decision without judgment or pressure.

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Correct Answer is D

Explanation

A. Locks the wheelchair after transferring the client: Locking the wheelchair should occur before the transfer to prevent it from rolling during the movement. Locking it after transferring compromises client safety and increases the risk of falls or injury.

B. Places the bed in a high position before transferring the client to the wheelchair: The bed should be placed in the lowest safe position to allow the client’s feet to touch the floor and to ease the transition to a lower surface like a wheelchair. A high bed position creates an unsafe height differential.

C. Uses a narrow stance when assisting the client to the wheelchair: A wide stance provides a stronger, more stable base of support, which is essential for safe body mechanics during a transfer. A narrow stance can lead to imbalance and injury to the AP or client.

D. Positions the wheelchair parallel to the client's bed: Positioning the wheelchair parallel or at a slight angle to the bed allows for easier and safer transfers. This minimizes turning and supports a smoother pivot, reducing strain on both the client and caregiver.

A. "I'll use focused breathing to control my pain." B. "I'll listen to my favorite music to take my mind off the pain." C. "I'll think about my grandfather's farm to reduce pain." D. "I'll learn to notice the sensation of muscle tension."

Correct Answer is C

Explanation

A. "I'll use focused breathing to control my pain." Focused breathing is a relaxation technique, but it is distinct from guided imagery. Guided imagery specifically involves creating vivid mental pictures to distract and soothe the mind.

B. "I'll listen to my favourite music to take my mind off the pain." Listening to music is a form of distraction or music therapy, which can help with pain management but is different from guided imagery, which relies on mental visualization.

C. "I'll think about my grandfather's farm to reduce pain." This statement reflects guided imagery, where the client mentally pictures a peaceful, pleasant scene to divert attention from pain and promote relaxation, showing understanding of the technique.

D. "I'll learn to notice the sensation of muscle tension." Noticing muscle tension is related to mindfulness or biofeedback, focusing on awareness of bodily sensations rather than the visualization involved in guided imagery.

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A nurse is caring for a client who is scheduled for a procedure, but the client states that they no longer want to undergo the procedure. Which of the following actions should the nurse take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is observing an assistive personnel (AP) transferring a client to a wheelchair. Which of the following actions by the AP indicates proper transfer technique?

Correct Answer is D

Explanation

A nurse is reinforcing teaching with a client about using guided imagery to manage chronic pain. Which of the following statements by the client indicates an understanding of this technique?

Correct Answer is C

Explanation

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