A nurse is caring for an older adult client diagnosed with a cerebrovascular accident and has right-sided paralysis and aphasia. The client's son tells the nurse it is his fault because he did not insist that his mother live with him. Which of the following responses should the nurse make?
"You are not responsible for your mother's stroke, but many people in your situation feel this way.”
"Your mother will be fine. You shouldn't worry so much.”
"Why do you blame yourself? You could not have prevented the stroke.”
"So, it seems that you feel responsible for what happened to your mother.”
The Correct Answer is D
The correct answer is choice d. "So, it seems that you feel responsible for what happened to your mother.”
Choice A rationale: This response attempts to reassure the son but may come off as dismissive of his feelings. It does not encourage further discussion or exploration of his emotions.
Choice B rationale: This response is overly reassuring and dismisses the son’s feelings of guilt. It does not address his emotional state or encourage him to express his concerns.
Choice C rationale: This response questions the son’s feelings directly, which might make him defensive. It does not validate his emotions or encourage him to talk more about his feelings.
Choice D rationale: This response acknowledges the son’s feelings and encourages him to express his emotions. It is a therapeutic communication technique that helps the son feel heard and understood, which is crucial in providing emotional support.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","D","E"]
Explanation
The correct answer is Choice A, Choice B, Choice D, Choice E.
Choice A rationale: Offering specific privileges for sustained weight gain acts as positive reinforcement, motivating the client to adhere to the treatment plan. It supports behavior change and helps in gradually restoring a healthy weight, vital in anorexia nervosa management.
Choice B rationale: Monitoring the client's weight daily allows for accurate tracking of progress and ensures timely intervention if weight loss continues. It helps the healthcare team make necessary adjustments to the treatment plan to meet nutritional and therapeutic goals.
Choice C rationale: Allowing the client to choose their meals can lead to poor nutritional choices due to their distorted perception of body image and fear of gaining weight. Structured meal plans are essential to ensure balanced nutrition and recovery in anorexia nervosa.
Choice D rationale: Providing the client with small meals frequently helps in preventing overwhelming feelings during meals and reduces the risk of refeeding syndrome. This approach promotes consistent nutritional intake and supports gradual weight gain.
Choice E rationale: Staying with the client during meals and for 1 hour afterward prevents purging behaviors and provides emotional support. It also ensures the client consumes the prescribed food, facilitating adherence to the nutritional plan and promoting recovery.
Correct Answer is ["B","C","D","E"]
Explanation
Choice A rationale:
Misplacing car keys is a common occurrence in many people's lives and is not necessarily indicative of Alzheimer's disease. It can happen to anyone due to various factors like stress or distraction.
Choice B rationale:
Difficulty performing familiar tasks is a potential early warning sign of Alzheimer's disease. This can include tasks that the person previously did with ease, such as cooking or dressing themselves. Alzheimer's disease affects cognitive abilities, including the ability to perform familiar tasks.
Choice C rationale:
Losing sense of time is another potential early warning sign of Alzheimer's disease. People with Alzheimer's may lose track of days or seasons, as the disease impacts their sense of time and memory.
Choice D rationale:
Problems with performing basic calculations can be a sign of cognitive decline, but it is not one of the primary early warning signs of Alzheimer's disease. This choice is less specific to Alzheimer's and could be related to other cognitive disorders as well.
Choice E rationale:
Becoming lost in a usually familiar environment is a significant early warning sign of Alzheimer's disease. Individuals with Alzheimer's may become disoriented even in places they know well, leading to confusion and anxiety. This is a result of the disease affecting their spatial memory and navigation skills.
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