The emergency department team is performing cardiopulmonary resuscitation on a patient when the patient’s spouse arrives. What is the first action the nurse should take?
Ask the spouse if they wish to be present during the resuscitation.
Request that the patient’s spouse sit in the waiting room.
Refer the patient’s spouse to the hospital’s crisis team.
Suggest that the spouse begin to pray for the patient.
The Correct Answer is A
Choice A rationale:
It is crucial to prioritize the patient's spouse's emotional needs and preferences during this highly stressful and sensitive situation. Offering the choice to be present during resuscitation demonstrates respect for their autonomy, promotes family- centered care, and facilitates coping mechanisms.
Key considerations supporting this approach:
Respect for Autonomy:
Patients and their loved ones have the right to make informed decisions about their care, including being present during resuscitation efforts.
Respecting this right fosters trust, empowers the spouse, and aligns with ethical principles of patient autonomy. Family-Centered Care:
Family-centered care recognizes the importance of family members in the patient's care and decision-making.
Inviting the spouse to be present demonstrates a commitment to including them in the care process and supporting their emotional needs.
Facilitating Coping Mechanisms:
Witnessing resuscitation efforts can be distressing, but it can also provide closure, acceptance, and the opportunity to say goodbye.
Some individuals find comfort in being present and actively involved, even in difficult circumstances. The nurse can provide emotional support and guidance throughout the process.
Potential Benefits of Presence:
Studies have shown that family presence during resuscitation can have positive outcomes, such as decreased anxiety and post- traumatic stress disorder (PTSD) symptoms in family members.
It may also contribute to greater satisfaction with care and a sense of peace for those who choose to be present.
Rationales for other choices:
Choice B: Requesting that the spouse sit in the waiting room may isolate them and increase their anxiety. It deprives them of the opportunity to be involved in decision-making and potentially delays their grieving process.
Choice C: While the hospital's crisis team can provide valuable support, immediate referral may not align with the spouse's immediate needs or preferences. It's essential to first assess their emotional state and offer the choice of being present.
Choice D: Suggesting prayer may be appropriate for some individuals, but it should not be the first or only option presented. It's important to respect the spouse's spiritual beliefs and offer a range of support options.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale:
Plague is a highly contagious and often fatal disease caused by the bacterium Yersinia pestis. It is transmitted to humans through the bites of infected fleas or by direct contact with infected animals or their tissues.
Plague can cause severe illness and death, even with prompt treatment. The mortality rate for untreated plague is 50-60%. Therefore, it is incorrect to state that plague produces a mild illness and generally has a low mortality rate.
Choice C rationale:
Smallpox is a highly contagious and deadly disease caused by the variola virus. It was eradicated in 1980, but there is still a risk that it could be used as a bioweapon.
Most people under the age of 40 have not been vaccinated against smallpox and therefore have no immunity to the disease. Therefore, it is incorrect to state that the majority of Americans have adequate innate immunity to smallpox.
Choice D rationale:
Safer food preparation practices have helped to decrease the incidence of foodborne illnesses.
However, foodborne illnesses can still be spread through international travel. Travelers can be exposed to contaminated food or water in other countries.
Therefore, safer food preparation practices do not eliminate the risk of foodborne illnesses being spread through international travel.
Correct Answer is B
Explanation
The correct answer is Choice B.
Choice A rationale: Massaging the site with scented oils is not recommended as it may further irritate the inflamed tissue. Additionally, scented oils can cause allergic reactions or skin irritation, worsening the client's discomfort.
Choice B rationale: Applying warm compresses to the site increases blood flow, reduces inflammation, and provides pain relief. Warm compresses also promote healing by improving circulation and reducing edema, making them an appropriate intervention for phlebitis.
Choice C rationale: Administering topical lidocaine to the site is generally not recommended without a prescription. Although it may provide localized pain relief, it can mask underlying issues and delay appropriate medical assessment and treatment.
Choice D rationale: Administering prescribed oral pain medication can provide systemic pain relief. However, it may not be as effective as a localized treatment for reducing inflammation and discomfort at the site of the peripheral vascular access device.
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