A nurse is reinforcing discharge teaching with a client who speaks a different language than the nurse. Which of the following actions should the nurse take?
Reinforce discharge teaching with the client's partner who speaks the languages of both the client and the nurse.
Ask a nurse from another unit who speaks the same language as the client to reinforce the discharge teaching.
Request that a medical interpreter assist with translating the discharge teaching for the client.
Use nonverbal communication with gestures to reinforce discharge teaching with the client.
The Correct Answer is C
Choice A Reason:
Reinforcing discharge teaching with the client's partner who speaks the languages of both the client and the nurse is not appropriate. While involving the client's partner may be helpful, it's essential to ensure that the information is accurately and comprehensively translated. Relying solely on the partner may not guarantee clear communication.
Choice B Reason:
Asking a nurse from another unit who speaks the same language as the client to reinforce the discharge teaching is inappropriate. While this option might be helpful if such a nurse is available, it may not always be practical to find a nurse who speaks the specific language required. Additionally, the nurse's expertise in the discharge instructions may vary.
Choice C Reason:
Requesting that a medical interpreter assist with translating the discharge teaching for the client is appropriate. Using a medical interpreter ensures accurate and clear communication, reducing the risk of misunderstandings. It promotes effective communication between the nurse and the client, ensuring that important information about post-discharge care is accurately conveyed.
Choice D Reason:
Using nonverbal communication with gestures to reinforce discharge teaching with the client is inappropriate. While nonverbal communication and gestures can be supplementary, relying solely on them may not convey detailed information accurately. Important details about medications, follow-up appointments, and self-care may be lost without verbal communication.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A Reason:
Adding 0.5 mL of diluent to the medication is inappropriate action. Ampules typically contain a single-dose of medication in a liquid form, and dilution is not necessary unless specified by the medication order or manufacturer.
Choice B Reason:
This is not necessary as the tip of the ampule is already sterile before opening. Cleansing after opening does not provide additional benefit and can introduce contaminants.
Choice C Reason:
Using a filter needle to aspirate the medication is inappropriate. Filter needles are not routinely used for administering medication from ample.
Choice D Reason:
This is not appropriate for ampules. Unlike vials, ampules do not require air to be injected. Air injection is necessary only for vials to create pressure, but ampules are opened and medication is drawn directly without the need for air.
Correct Answer is C
Explanation
Choice A Reason:
Pushing the skin down while gently removing the tape is incorrect. Pushing the skin while removing tape could cause unnecessary discomfort or trauma to the skin and the incision area. Gentle removal of tape without pulling the skin is recommended to avoid skin injury.
Choice B Reason:
Drying the incision with sterile gauze pads is incorrect. Generally, it's advisable not to dry the incision site with sterile gauze pads as this might cause trauma or disruption to the healing tissues. Patting the incision site dry or allowing it to air dry gently after cleansing is preferable.
Choice C Reason:
Lifting the soiled dressing so that the underside faces the client is correct. Lifting the soiled dressing in a manner that the underside faces the client helps prevent potential contamination of the wound by minimizing contact between the external surface of the dressing and the incision site. This technique reduces the risk of introducing pathogens into the wound during the dressing change.
Choice D Reason:
Cleaning around the drain site using horizontal strokes is incorrect. When cleaning around the drain site, it's typically recommended to use gentle and careful motions without specific emphasis on strokes, as this might cause friction or trauma to the area around the drain. Instead, using gentle circular motions or dabbing around the site is often advised for wound care.

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