A parish nurse is leading a support group for clients whose family members have committed suicide. Which of the following strategies should the nurse plan to use during the group session?

The correct answer is:Choices c, e, g, h, and a.

Choice A rationale (Current medications): The client is taking Ibuprofen 800 mg three times daily as needed for arthritis pain.Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that can cause gastrointestinal irritation, ulcers, and bleeding, especially when used at high doses or for a prolonged period12. Given the client’s symptoms of abdominal pain and a history of dark, tarry stool, the medication could be contributing to these symptoms and warrants further investigation.

Choice B rationale (Temperature): The client’s temperature is 37.5° C (99.5° F), which is within the normal range34. Therefore, it does not require immediate follow-up.

Choice C rationale (Hemoglobin and hematocrit): The client’s hemoglobin level is 9.1 g/dL, which is lower than the normal range of about 13.0 to 17.5 g/dL for adult males and 12.0 to 15.5 g/dL for adult females56.The client’s hematocrit is 27%, which is also lower than the normal range of about 38.3% to 48.6% for adult males and 35.5% to 44.9% for adult females7.Low hemoglobin and hematocrit levels can indicate anemia, which could explain the client’s reported fatigue and pale mucous membranes87.

Choice D rationale (WBC count): The client’s WBC count is 6,700/mm3, which falls within the normal range of about 4,500 to 11,000 WBCs per microliter910. Therefore, it does not require immediate follow-up.

Choice E rationale (Blood pressure): The client’s blood pressure is 90/50 mm Hg, which is lower than the normal range11. Low blood pressure can cause symptoms such as dizziness, fainting, or blurred vision and requires immediate follow-up.

Choice F rationale (Respiratory rate): The client’s respiratory rate is 18 breaths per minute, which is within the normal range for adults of about 12 to 20 breaths per minute412. Therefore, it does not require immediate follow-up.

Choice G rationale (Stool results): The client’s stool tested positive for blood (Hemoccult positive), which could indicate gastrointestinal bleeding13. This finding, combined with the client’s reported abdominal pain and history of dark, tarry stool, requires immediate follow-up.

Choice H rationale (Heart rate): The client’s heart rate is 118 beats per minute, which is higher than the normal range for adults of about 60 to 100 beats per minute14.A high heart rate, or tachycardia, can be caused by factors such as stress, anxiety, physical exertion, dehydration, and certain medical conditions14. Given the client’s reported symptoms and medical history, this finding warrants immediate follow-up.

Choice A rationale:

Covering appliance cords with throw rugs is not an appropriate action to address the needs of a client with vision loss and medication management. While it promotes safety by reducing tripping hazards, it does not directly address the client's medication administration needs. Implementing measures that specifically assist the client in managing medications safely is essential in this scenario.

Choice B rationale:

Visiting the client once per month to assess medication usage is insufficient for an older adult with vision loss who takes medications throughout the day. Regular and more frequent assessments are necessary to ensure the client's safety and adherence to the medication regimen. The nurse should consider more proactive measures to support the client, such as providing medication organizers or arranging for a home healthcare aide to assist with medication administration daily.

Choice C rationale:

This is the correct answer. Using container lids of different shapes to indicate times of administration is an effective strategy for clients with vision loss. Associating specific shapes with different times of the day helps the client differentiate between medications, promoting accurate dosing. This method is tactile and easy for the client to understand, enhancing their ability to manage medications independently and safely.

Choice D rationale:

Rearranging furniture to clear walkways is a general safety measure but does not specifically address the client's medication administration needs. While it can prevent falls and accidents, it does not facilitate the client's ability to distinguish between different medications or their dosing schedules. The focus should be on implementing strategies that directly support the client in managing their medications effectively despite their visual impairment.