A nurse on a mental health unit is caring for a client who has anorexia nervosa. Which of the following statements by the nurse promotes the ethical principle of client autonomy?

“It is your choice to share personal information during group therapy.”

"I will only discuss your medical information with the health care team."

“I will be truthful when answering questions about your treatment”

"The nursing staff here will provide you with nonjudgmental care”

Answer and Explanation

The Correct Answer is A

A. “It is your choice to share personal information during group therapy.”: This statement supports client autonomy by emphasizing the client’s right to make decisions about their own participation and what personal information to disclose. Respecting autonomy involves allowing clients to make informed choices about their care and interactions.

B. "I will only discuss your medical information with the health care team.": This reflects the ethical principle of confidentiality, protecting privacy, but does not directly address autonomy.

C. “I will be truthful when answering questions about your treatment”: Truthfulness relates to veracity, ensuring honesty in the nurse-client relationship, but does not specifically promote autonomy.

D. "The nursing staff here will provide you with nonjudgmental care”: Providing nonjudgmental care supports beneficence and a therapeutic environment but does not directly empower the client to make their own decisions.

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Correct Answer is B

Explanation

A. Hematuria: Hematuria is not a typical adverse effect of methylergonovine. This medication primarily affects uterine smooth muscle and vascular tone, so urinary complications are uncommon.

B. Elevated blood pressure: Methylergonovine is a potent vasoconstrictor, which can lead to hypertension. Monitoring blood pressure is essential because severe elevations can increase the risk of stroke or cardiac complications, especially in clients with preexisting hypertension.

C. Uterine relaxation: Methylergonovine promotes uterine contraction, not relaxation. Uterine relaxation would be contrary to the intended therapeutic effect of preventing or controlling postpartum hemorrhage.

D. Diarrhea: Gastrointestinal upset, including nausea, vomiting, or diarrhea, can occur but is less common and typically mild. Blood pressure changes are the primary adverse effect requiring close monitoring.

A. Auscultate the client's lung sounds. B. Check the client's weight C. Check the client's apical pulse D. Obtain the clients oxygen saturation

Correct Answer is C

Explanation

A. Auscultate the client's lung sounds: While assessing lung sounds is an important part of the overall assessment for a client with heart failure (to check for pulmonary edema/crackles), it is not a specific requirement for the administration of digoxin. It helps evaluate the effectiveness of the treatment over time but does not determine if the current dose is safe to give.

B. Check the client's weight: Daily weights are essential for monitoring fluid volume status in heart failure patients. However, like lung sounds, this is an assessment of the disease progression rather than a safety check for the medication's immediate effect on the heart's electrical system.

C. Check the client's apical pulse: Digoxin can cause bradycardia and other arrhythmias. The nurse must assess the apical pulse for a full minute before administration and withhold the medication if the rate is below the provider’s prescribed parameters (commonly <60 bpm in adults).

D. Obtain the client's oxygen saturation: Oxygen saturation provides information about respiratory status but does not directly influence the decision to administer digoxin.

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A nurse on a mental health unit is caring for a client who has anorexia nervosa. Which of the following statements by the nurse promotes the ethical principle of client autonomy?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has been given methylergonovine intramuscularly for a postpartum hemorrhage. The nurse should monitor for which of the following adverse effects?

Correct Answer is B

Explanation

A nurse is preparing to administer a dose of digoxin to a client who is experiencing heart failure. Which of the following actions should the nurse take prior to administering this medication?

Correct Answer is C

Explanation

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