A nurse is preparing a client for surgery. The client expresses concern that someone might steal her purse during the procedure. Which of the following actions should the nurse take?
Tell the client to leave her purse in a drawer of the bedside table.
Offer to place the purse in the facility safe.
Offer to store the purse at the nurses' station.
Place the purse in the clothing bag with the client's other belongings.
The Correct Answer is B
Choice A Reason:
Telling the client to leave her purse in a drawer of the bedside table is incorrect. Leaving the purse unattended in a bedside table drawer may not ensure its safety, as there could still be a risk of theft. Additionally, leaving valuables unattended in a hospital room may not be the safest option.
Choice B Reason:
Offering to place the purse in the facility safe is correct. Placing the purse in the facility safe is a secure option for safeguarding the client's belongings during surgery. It provides reassurance to the client that her valuables will be protected while she undergoes the procedure.
Choice C Reason:
Offering to store the purse at the nurses' station is incorrect. While storing the purse at the nurses' station may be a better option than leaving it in the client's room, it may not provide the same level of security as placing it in the facility safe. The nurses' station may be a busy area with various staff members coming and going, increasing the risk of theft.
Choice D Reason:
Placing the purse in the clothing bag with the client's other belongings is incorrect. Placing the purse in the clothing bag with the client's other belongings may not offer sufficient security, as the bag could still be accessible to unauthorized individuals. It's important to provide a secure storage option, such as the facility safe, to minimize the risk of theft.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","C"]
Explanation
Choice A Reason:
Providing written information to a client regarding palliative care is correct. Advocating for the client's autonomy and right to information by providing written materials about palliative care empowers the client to make informed decisions about their care.
Choice B Reason:
Documenting a client's refusal to take a prescribed medication is incorrect. While documenting a client's refusal is important for accurate medical records, it is not an example of advocacy. Advocacy involves actively supporting the client's rights, preferences, and needs.
Choice C Reason:
Obtaining an interpreter for a client who speaks a different language than the nurse is correct. Advocating for effective communication ensures that the client can fully understand and participate in their care, regardless of language barriers. Obtaining an interpreter facilitates communication and promotes the client's right to understand and be understood.
Choice D Reason:
Initiating IV access on a client who has dementia while he is sleeping is incorrect. This scenario raises ethical concerns as it involves performing a procedure on a client who is unable to provide consent due to being asleep and having dementia. Without explicit consent or a medical emergency necessitating immediate intervention, initiating IV access in this situation may not align with client advocacy principles.
Choice E Reason:
Implementing a client's plan of care based upon nursing goals is incorrect. While implementing a client's plan of care is part of the nurse's role, it is not necessarily an example of advocacy. Advocacy involves actively promoting and safeguarding the client's rights, preferences, and well-being, which may sometimes involve advocating for modifications to the plan of care based on the client's needs and goals.
Correct Answer is C
Explanation
Choice A Reason:
Medicating the client with alprazolam, should not be the first action as it involves administering medication that could mask underlying issues and may not be appropriate without further assessment.
Choice B Reason:
Reorienting the client to his surroundings, is important for addressing confusion, but it should not be the first action until the nurse has ruled out any immediate physiological concerns.
Choice C Reason:
When a client presents with confusion and agitation after returning from an acute care facility, it's important for the nurse to prioritize assessing the client's physiological status by measuring vital signs. Changes in vital signs could indicate underlying medical issues such as infection, dehydration, or other physiological disturbances that may be contributing to the client's symptoms.
Choice D Reason:
Offering reassurance to the family, is important for providing support, but it should not be the first action as it does not directly address the client's immediate needs related to confusion and agitation.
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