A nurse is discussing community support services with an adult client who has cognitive disabilities and their guardian. The guardian reports that the client's need for help with activities of daily living has increased recently. Which of the following referrals is most important to promote the client's quality of life?
Community health nurse
Respite care provider
Dietician
Occupational therapist
The Correct Answer is D
A. A community health nurse can provide education, medication management, and health monitoring, but they do not specifically focus on ADL assistance.
B. Respite care provides temporary relief for caregivers, but it does not directly help the client develop skills to maintain independence.
C. A dietitian focuses on nutritional needs and meal planning, but this does not directly address the increased difficulty with ADLs.
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Correct Answer is C
Explanation
A. "The food is not great, but it is nice not having to do all of my own cooking." This statement shows acceptance by acknowledging both the challenges and benefits of the transition.
B. "When I go out, I've been using public transportation since I can't drive anymore." This reflects adaptation to the changes by finding alternative transportation.
C. "I don't want to go to the activity room because none of the other residents can hear." This suggests social withdrawal and frustration, which may indicate difficulty accepting the transition to assisted living.
D. "The staff sometimes have to remind me to use a cane when I walk in the hall." This shows acceptance of help from staff, which suggests an adjustment to the new environment rather than resistance.
Correct Answer is B
Explanation
A. "Although this is your first incident, we will have to terminate your employment." This response is punitive and does not align with a just culture, which seeks to identify the cause of errors rather than immediately disciplining staff.
B. "We will review the incident report to determine the cause of the missed medication." This aligns with just culture principles by focusing on finding the root cause (e.g., workload issues, system inefficiencies) rather than blaming the nurse.
C. "I will need to report this incident to the state board of nursing." A missed medication dose that caused no harm typically does not require reporting to the state board. Just culture focuses on improving processes rather than unnecessary punishment.
D. "The facility's legal team will be contacting you to discuss the incident." Involving legal action for a minor, non-harmful event is excessive and contradicts just culture, which emphasizes education, accountability, and system improvements over legal consequences.
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