A nurse begins to bathe a newly admitted client who reports that they have not had anything to eat that day.
The nurse interrupts the bath and obtains a healthy meal for the client.
This action by the nurse is an example of which of the following?
Countertransference.
Promoting trust.
Boundary crossing.
Veracity.
The Correct Answer is B
Choice A rationale: Countertransference is not the appropriate concept in this scenario. Countertransference refers to the nurse's emotional response to the client, which may be based on the nurse's unresolved issues and can negatively affect the therapeutic relationship. In this case, the nurse's actions are not driven by unresolved issues but by a desire to meet the client's basic needs.
Choice B rationale: Promoting trust is the most suitable explanation for the nurse's actions. By interrupting the bath and providing a healthy meal to a newly admitted client who hasn't eaten all day, the nurse is demonstrating empathy, compassion, and a commitment to meeting the client's physiological needs. This action helps build trust between the nurse and the client, as the client can see that their well-being is a priority.
Choice C rationale: Boundary crossing refers to actions that may blur or violate professional boundaries between a nurse and a client. While the nurse is going beyond the routine bath to provide a meal, this action is justified by the client's immediate need and doesn't constitute an inappropriate boundary crossing. The nurse is still maintaining professionalism in caring for the client.
Choice D rationale: Veracity is the principle of truth-telling and honesty in healthcare. It doesn't directly apply to this situation since the nurse's actions are not about providing information or disclosing something to the client. Instead, the nurse's primary concern is the client's nutritional well-being.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Correct answer is: B. 16 lb.
Choice A rationale: 32 lb. is too much weight gain for a client whose prepregnancy BMI was 30.5. According to the Institute of Medicine (IOM) guidelines, obese women (BMI greater than or equal to 30) should only gain 11 to 20 lb.during pregnancy12.Excessive weight gain can increase the risk of gestational diabetes, hypertension, cesarean delivery, and postpartum weight retention1.
Choice B rationale: 16 lb. is an acceptable weight gain for a client whose prepregnancy BMI was 30.5. This is within the recommended range of 11 to 20 lb.for obese women (BMI greater than or equal to 30) by the IOM guidelines12.Adequate weight gain can help ensure optimal fetal growth and development, as well as maternal health1.
Choice C rationale: 24 lb. is too much weight gain for a client whose prepregnancy BMI was 30.5. This exceeds the recommended range of 11 to 20 lb.for obese women (BMI greater than or equal to 30) by the IOM guidelines12.Excessive weight gain can increase the risk of gestational diabetes, hypertension, cesarean delivery, and postpartum weight retention1.
Correct Answer is {"A":{"answers":"A,B"},"B":{"answers":"B"},"C":{"answers":"A,B"},"D":{"answers":"B"}}
Explanation
Blood pressure: This finding is consistent with preeclampsia, but not HELLP syndrome.Preeclampsia is defined as new-onset hypertension (systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg) after 20 weeks of gestation, with or without proteinuria.HELLP syndrome is a severe form of preeclampsia that involves hemolysis, elevated liver enzymes, and low platelets, but does not necessarily cause hypertension. Hemoglobin: This finding is consistent with HELLP syndrome, but not preeclampsia.
Hemolysis is one of the main features of HELLP syndrome, which causes a decrease in hemoglobin levels.Preeclampsia does not typically affect hemoglobin levels, unless there is significant blood loss or hemodilution.
Platelet count: This finding is consistent with both preeclampsia and HELLP syndrome.Low platelets (thrombocytopenia) are a common complication of preeclampsia, especially in severe cases.They are also a diagnostic criterion for HELLP syndrome, which requires a platelet count of less than 100,000/mm3.
Alanine aminotransferase: This finding is consistent with HELLP syndrome, but not preeclampsia.Elevated liver enzymes are another hallmark of HELLP syndrome, which indicates liver damage and inflammation.Preeclampsia may cause mild elevations of liver enzymes, but not to the same extent as HELLP syndrome.
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