The nurse is assisting with patient data collection in a clinic. The nurse is assigned to a young female patient who has an older male friend present at her bedside. The patient is nervous, timid, very thin, and with poor hygiene and lets the friend answer all of the nurse's questions. What actions should the nurse take?
Whisper to patient that she will be saved.
Confront the family friend to allow the patient to ask questions.
Consult the health care team about the suspicions and call local authorities to investigate.
Ask the patient if she feels safe, while the friend is in the room.
The Correct Answer is D
Explanation:
A. Whisper to the patient that she will be saved.
This action is inappropriate and does not address the underlying issues of the patient's condition or the presence of the family friend. Whispering such a statement may also be confusing or alarming to the patient.
B. Confront the family friend to allow the patient to ask questions.
While it's important to facilitate open communication with the patient, confronting the family friend directly may not be the most effective approach initially. It's crucial to first assess the patient's comfort level and safety before addressing the situation with the friend.
C. Consult the healthcare team about the suspicions and call local authorities to investigate.
Jumping to conclusions and involving authorities without gathering more information or assessing the patient's feelings directly could escalate the situation unnecessarily. It's important to handle such concerns with sensitivity and professionalism, involving appropriate resources only when needed.
D. Ask the patient if she feels safe, while the friend is in the room.
This is the most appropriate action initially. By directly asking the patient about her feelings of safety, the nurse can gauge the patient's comfort level and assess any potential concerns or risks. This approach allows the nurse to gather information and address any issues in a supportive and patient-centered manner. If the patient expresses concerns or discomfort, further assessment and appropriate interventions can be implemented, which may include involving other members of the healthcare team or authorities if necessary.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Explanation:
A. Battery: Battery refers to intentional harmful or offensive touching without consent. In the context of healthcare, it usually involves physical contact or procedures performed without the patient's consent. An inadvertent medication error, even if it causes harm, does not typically constitute battery unless there was an intentional act of administering the wrong medication against the patient's will.
B. Assault: Assault is the threat of harmful or offensive contact. It involves creating a reasonable apprehension of imminent harmful or offensive contact in the patient's mind. An inadvertent medication error, while it may cause harm, does not typically constitute assault unless there was an intentional threat of harm made to the patient.
C. Abuse: Abuse involves the intentional mistreatment or harm of another person. An inadvertent medication error is not considered abuse unless there was an intentional act to harm the patient.
D. Malpractice: Malpractice refers to professional negligence or failure to provide the standard of care expected in a particular profession, such as nursing. In the scenario described, the inadvertent medication error resulting in a severe allergic reaction and prolonging the client's hospitalization could be considered a case of malpractice. The nurse failed to meet the standard of care expected in administering medications safely, leading to harm to the patient.
Correct Answer is B
Explanation
Explanation:
A. Have a pen and paper.
Having a pen and paper can be helpful during the conversation as it allows the nurse to jot down important points, keywords, or reminders. However, it's not directly related to active listening itself but can aid in retaining and recalling information.
B. Use intermittent eye contact.
Intermittent eye contact is a crucial aspect of active listening. It shows that the nurse is engaged and attentive to the client's communication. However, it's essential to maintain a balance and avoid prolonged staring, which can be perceived as intimidating or intrusive.
C. Sit side-by-side with the client.
Sitting side-by-side with the client can create a sense of partnership and equality in the conversation. It can also help in establishing a comfortable and open environment for communication, which is beneficial for active listening.
D. Lean back in the chair.
Leaning back in the chair can convey a relaxed and open posture, which can contribute to a positive communication atmosphere. However, it's crucial to maintain an attentive posture and avoid appearing disinterested or unengaged.
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