A nurse on a medical-surgical unit is preparing to administer an influenza vaccine to a client.
The client tells the nurse, "I no longer want to receive this vaccine."
Which of the following responses should the nurse make?
"If I were you, I would get the vaccine to keep my family safe.”
"Influenza can be very serious to anyone who does not receive the vaccine.”
"The influenza vaccine is strongly encouraged, but I understand you would like to decline right now.”
"The influenza vaccine is mandatory for all clients before discharge, so you will need to sign an against medical advice form.”
The Correct Answer is C
The correct answer is Choice C.
Choice A rationale:
- This response is not appropriate because it is judgmental and may make the client feel defensive.
- It is important for the nurse to respect the client's right to make their own decisions about their health care.
- Telling the client what they should do can undermine their autonomy and potentially damage the nurse-client relationship.
- It's crucial for the nurse to remain objective and avoid imposing their personal opinions or beliefs onto the client.
Choice B rationale:
- This response is also not appropriate because it is using scare tactics to try to persuade the client to get the vaccine.
- This approach can be counterproductive and may further alienate the client.
- It's important to provide accurate information about the risks and benefits of the vaccine in a neutral and non-threatening manner.
Choice C rationale:
- This is the most appropriate response because it acknowledges the client's right to refuse the vaccine while still encouraging them to get it.
- It also demonstrates respect for the client's autonomy and validates their feelings.
- This approach is more likely to foster a positive nurse-client relationship and keep the door open for future discussions about vaccination.
Choice D rationale:
- This response is not accurate because the influenza vaccine is not mandatory for all clients before discharge.
- It is important for the nurse to provide accurate information to the client.
- Threatening the client with an against medical advice form is not appropriate and may be considered a form of coercion.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Ranitidine is a histamine H2-receptor antagonist that blocks histamine-mediated gastric acid secretion.
Antacids can interfere with the absorption of ranitidine, so it is important to separate their administration by at least 1 hour.
Choice A is wrong because aspirin is a type of nonsteroidal anti-inflammatory drug (NSAID) which can increase the risk of peptic ulcers.
Choice C is wrong because fine hand tremors are not a known side effect of ranitidine.
Choice D is wrong because there is no need to avoid dairy products when taking ranitidine.
Correct Answer is A
Explanation
Spironolactone is a potassium-sparing diuretic that can increase potassium levels in the blood.
It is important for clients taking spironolactone to limit their intake of potassium-rich foods to prevent hyperkalemia (high potassium levels).
Choice B is wrong because “I will take the medication on an empty stomach,” is not the correct answer because spironolactone can be taken with or without food.
Choice C is wrong because “I will use salt substitutes in place of table salt,” is not the correct answer because many salt substitutes contain potassium and can increase the risk of hyperkalemia.
Choice D is wrong because “I will double up on my medication if I miss a dose,” is not the correct answer because it is not recommended to double up on medication if a dose is missed.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today