A nurse is teaching the caregiver of a client who has advanced Alzheimer's disease about home safety. Which of the following statements by the caregiver indicates an understanding of the teaching?

"I will notify law enforcement within 2 hours if he cannot be found."

"I will give his most recent photo to the police."

"I will place a sliding bolt lock just above the doorknob."

"I will ensure the bedroom is dark while he is sleeping at night."

Answer and Explanation

The Correct Answer is C

Choice A reason: Notifying law enforcement within 2 hours if the person cannot be found is important, but immediate action is usually recommended in such cases. The sooner the authorities are alerted, the better the chances of locating the individual safely.

Choice B reason: Giving the most recent photo to the police is a proactive step in case the person goes missing. It can help law enforcement quickly disseminate the information and aid in the search. However, this is a reactive measure rather than a preventive one.

Choice C reason: Placing a sliding bolt lock just above the doorknob can prevent the individual from wandering, which is a common and dangerous issue in people with advanced Alzheimer's disease. This measure helps ensure the person's safety by preventing unsupervised exits from the home.

Choice D reason: Ensuring the bedroom is dark while the person is sleeping may not be advisable. Adequate night lighting is important for preventing falls if the person needs to get up during the night. A completely dark room can increase the risk of injury.

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Correct Answer is D

Explanation

Choice A reason: Encouraging the client to internalize their feelings related to the loss is not advisable. Grief is a personal experience, and expressing emotions is a healthy part of the grieving process. Internalizing feelings can lead to unresolved grief and potential mental health issues.

Choice B reason: Changing the subject when the client expresses anger about their situation is not supportive. Anger is a natural stage of the grieving process, and it's important for the nurse to acknowledge the client's feelings and provide a safe space for them to express their emotions.

Choice C reason: Allowing the client to be alone during times of spiritual inadequacy may not be beneficial. While respecting the client's need for solitude is important, it's also crucial to offer support and presence, as isolation can exacerbate feelings of loneliness and despair.

Choice D reason: Offering to contact the client's spiritual advisor is a supportive action that can help meet the client's spiritual needs. Spiritual care is an integral part of holistic nursing care, and connecting the client with their spiritual support system can provide comfort and aid in the grieving process.

A. "The client generally shares his feelings during group therapy sessions." B. "The client is just like my brother who finally overcame his habit." C. "The client asked me to go on a date with him, but I refused." D. "The client needs to accept responsibility for his substance use."

Correct Answer is B

Explanation

Choice A reason: This statement reflects a neutral observation of the client's behavior in therapy and does not indicate countertransference. Sharing feelings during group therapy sessions is a common and expected part of the therapeutic process, and the staff nurse's comment does not reveal any personal emotional response or projection onto the client.

Choice B reason: This statement is a clear example of countertransference. The staff nurse is identifying the client with a personal family member, which can cloud professional judgment. Such an emotional entanglement may lead to biased care, as the nurse may treat the client based on personal experiences with their brother rather than the client's individual needs and circumstances.

Choice C reason: Declining a client's inappropriate request for a date is a professional boundary that must be maintained. This statement does not reflect countertransference but rather appropriate professional conduct. It is important for the charge nurse to recognize that maintaining boundaries is crucial in a therapeutic setting, especially in cases of substance use disorder where clients may exhibit boundary-testing behaviors.

Choice D reason: This statement could be seen as a professional opinion regarding the client's need for accountability in their recovery process. It does not necessarily indicate countertransference unless the staff nurse's insistence on responsibility is driven by personal feelings or unresolved issues related to substance use.

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A nurse is teaching the caregiver of a client who has advanced Alzheimer's disease about home safety. Which of the following statements by the caregiver indicates an understanding of the teaching?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who is going through the grieving process. Which of the following actions should the nurse take to meet the client's spiritual needs?

Correct Answer is D

Explanation

A charge nurse is discussing the care of a client who has a substance use disorder with a staff nurse. Which of the following statements by the staff nurse should the charge nurse identify as countertransference?

Correct Answer is B

Explanation

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