A nurse is caring for an older adult client who tells the nurse, "I have smoked one pack of cigarettes every day for the last 60 years." Which of the following actions should the nurse take next?

Ask what the client knows about the eﬀects of smoking.

Work with the client to establish a quit date.

Suggest that the client use nicotine gum to facilitate quitting.

Refer the client to a local smoking cessation program.

Answer and Explanation

The Correct Answer is A

If a nurse is caring for an older adult client who tells the nurse that they have smoked one pack of cigarettes every day for the last 60 years, the next action the nurse should take is to ask what the client knows about the eﬀects of smoking. This will help the nurse assess the client's knowledge and understanding of the risks associated with smoking and provide an opportunity for education.

Option b is incorrect because working with the client to establish a quit date is important but not the next intervention.

Option c is incorrect because suggesting that the client use nicotine gum to facilitate quitting is important but not the next intervention.

Option d is incorrect because referring the client to a local smoking cessation program is important but not the next intervention.

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Correct Answer is ["F"]

Explanation

f) Skin surrounding the stoma is reddened and appears irritated.

The information that requires intervention by the nurse is that the skin surrounding the stoma is reddened and appears irritated. This may indicate that the client is experiencing skin irritation or breakdown, which can lead to infection or other complications. The nurse should assess the skin and initiate appropriate interventions to prevent further skin damage.

Options a, b, c, d, e, and g do not necessarily require intervention by the nurse. A pink ileostomy stoma and moderate brown liquid stool drainage are normal findings. The client's refusal to look at the stoma or learn about stoma care may be concerning, but it is not an immediate priority for intervention. An intake of 2,200 mL over 24 hours and a urine output of 650 mL over 24 hours are within normal limits.

A. Find an assistive personnel who speaks the client's language. B. Ask a family member of the client to translate for the nurse. C. Arrange for a video conference with an interpreter who speaks the client's language. D. Speak to the client while indicating printed instructions in the client's language.

Correct Answer is C

Explanation

The nurse should arrange for a video conference with an interpreter who speaks the client's language to provide discharge instructions. This ensures that the client receives accurate and complete information in a language they understand. The other

a. Assistive personnel may not be trained or qualified to provide medical interpretation.

b. Family members may not have the necessary medical knowledge to accurately translate medical information.

d. Simply indicating printed instructions in the client's language may not be sufficient to ensure the client understands the information.

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A nurse is caring for an older adult client who tells the nurse, "I have smoked one pack of cigarettes every day for the last 60 years." Which of the following actions should the nurse take next?

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Naxlex Comprehensive Predictor Exams

Correct Answer is ["F"]

Explanation

A nurse is planning to provide discharge instructions to a client who does not speak the same language as the nurse. Which of the following actions should the nurse take?

Correct Answer is C

Explanation

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