A nurse is caring for the client who has Ménière's disease and asks if he is allowed to ambulate independently. Which of the following responses should the nurse make?
"Yes, you are free to move around as you wish."
"We will have to get a prescription from your provider.
"No, you are on strict bedrest and must not be up."
"Please ring for assistance when you wish to get out of bed."
The Correct Answer is D
A. Allowing free movement could increase the risk of falls due to dizziness.
B. While involving the provider is important, immediate safety measures should be communicated directly.
C. Strict bedrest is not typically necessary, and movement can help prevent complications like blood clots.
D. Assisting the client when they wish to get out of bed ensures safety by preventing falls, which are a significant risk for those with Ménière's disease due to vertigo.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. The T wave in the inverted position can indicate ischemia or electrolyte imbalances but does not define normal sinus rhythm.
B. The P wave falling before the QRS complex is characteristic of normal sinus rhythm.
C. A QRS duration of 0.20 seconds is within the normal range and does not specifically define normal sinus rhythm.
D. The P-R interval typically ranges from 0.12 to 0.20 seconds, and a slightly prolonged interval here wouldn't necessarily exclude normal sinus rhythm.
Correct Answer is D
Explanation
A. Dismissing the client's feelings does not address the client's anxiety.
B. Comparing the client to others does not address her individual concerns and may feel dismissive.
C. Asking "why" questions can come across as judgmental and may not encourage open communication.
D. Encouraging the client to express her concerns is a therapeutic communication technique that validates her feelings and can help reduce anxiety.
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