A nurse is caring for a young adult client who is postoperative and requires physical therapy, pain management, and dietary advancement.
The nurse enters the client’s room and finds them dressing and stating that they are going home. Which of the following actions should the nurse take?
Tell the client that the surgeon will prescribe restraints if they try to leave.
Explain to the client that they cannot leave until the surgeon discharges them.
Have the client sign an against medical advice form.
Administer a sedative medication to the client.
None
None
The Correct Answer is C
The correct answer is choice B: Explain to the client that they cannot leave until the surgeon discharges them.
Choice B rationale: The nurse should explain the importance of following the surgeon's orders and the potential consequences of leaving before being officially discharged. This approach provides patient education and promotes collaboration between the client and the health care team. It also ensures the client understands that leaving without proper discharge could lead to complications or inadequate recovery.
Choice A rationale: Threatening the client with restraints is not an appropriate action, as it may cause undue stress and escalate the situation. Restraints should only be used as a last resort in cases where the client poses an immediate risk of harm to themselves or others.
Choice C rationale: While having the client sign an against medical advice (AMA) form might be appropriate if the client insists on leaving, the nurse should first attempt to educate the client on the importance of following the surgeon's orders and collaborate with the client to resolve any concerns or issues leading to their desire to leave.
Choice D rationale: Administering a sedative medication is not an appropriate action in this situation. Sedation should only be used when medically necessary and not as a means to control a client's behavior or decisions.
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Related Questions
Correct Answer is A
Explanation
Aspiration is when food or liquid enters the airway and causes choking or infection. Speech therapists can teach clients exercises to strengthen the muscles involved in swallowing, as well as strategies to prevent aspiration, such as changing the position of the head or the texture of the food.
Choice B is wrong because respiratory therapists help clients with breathing problems, not swallowing problems.
They may provide oxygen therapy, chest physiotherapy, or mechanical ventilation.
Choice C is wrong because physical therapists help clients with mobility problems, not swallowing problems.
They may provide exercises, massage, or assistive devices to improve movement and function.
Choice D is wrong because occupational therapists help clients with daily living activities, not swallowing problems.
They may provide training, adaptive equipment, or environmental modifications to enhance independence and quality of life.
Dysphagia is a medical term for swallowing difficulties.
It can be caused by various conditions that affect the nerves or muscles involved in swallowing, such as stroke, head injury, Parkinson’s disease, or esophageal cancer.
Dysphagia can lead to complications such as malnutrition, dehydration, or aspiration pneumonia.
Correct Answer is B
Explanation
The correct answer is choice B. Palliative care is a type of care that improves the quality of life of patients and their families who are facing problems associated with life-threatening illness.
It prevents and relieves suffering through the early identification, correct assessment and treatment of pain and other problems, whether physical, psychosocial or spiritual.
Palliative care also provides emotional support to the patients and their families during the illness.
Therefore, choice B indicates an understanding of the teaching.
Choice A is wrong because it contradicts the goal of palliative care to address the spiritual needs of the patients and their families.
Spiritual advisors can help patients cope with their illness and find meaning and purpose in their situation.
Choice C is wrong because it denies the patient the opportunity to express their feelings and concerns about their illness.
Palliative care involves open and honest communication between the patients, their families and the health care team.
Discussing the illness can help patients make informed decisions about their care and prepare for the end of life.
Choice D is wrong because it goes against the principle of palliative care to respect the patient’s wishes and preferences regarding their treatment.
Resuscitation is a procedure that attempts to revive someone from apparent death or unconsciousness.
Some patients may not want resuscitation if they have a terminal illness or a poor quality of life.
They may have an advance directive or a living will that states their preferences for end-of-life care.
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