The nurse is conducting an initial admission assessment for a woman who is a Jehovah's Witness and is scheduled to deliver a baby by Cesarean section within the next 24 hours. Which action should the nurse take?
Commend the client for her patience after a long wait in the admission process.
Determine the client's decision about homologous blood transfusion.
Arrange for a ritual meeting together with other Jehovah's Witnesses before surgery.
Obtain primary source of information from the head of the spiritual group.
The Correct Answer is B
A. Commend the client for her patience after a long wait in the admission process is not appropriate at this time. While acknowledging the client's feelings is important, it is not the most relevant or immediate intervention for this situation.
B. Determine the client's decision about homologous blood transfusion is the most important action. Jehovah's Witnesses generally refuse blood transfusions based on their religious beliefs. The nurse should assess the client’s wishes regarding blood transfusions to ensure informed consent and respect for her beliefs.
C. Arrange for a ritual meeting together with other Jehovah's Witnesses before surgery is not the most immediate action. While spiritual support is important, the priority is addressing the client’s medical decisions, particularly regarding blood transfusions, which may impact her care.
D. Obtain primary source of information from the head of the spiritual group is unnecessary. The client herself is the primary source of information about her beliefs and preferences, and the nurse should focus on her individual decisions rather than seeking information from a religious leader.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["2.5"]
Explanation
Convert mcg to mg: 1 mg = 1000 mcg, so 125 mcg = 125/1000 = 0.125 mg
· Set up a proportion: (Desired dose / Concentration) = Volume to administer
0.125 mg / 0.05 mg/mL = X mL
· Solve for X: X = 2.5 mL
Correct Answer is A
Explanation
A. Call the pharmacy to see which medications should be taken indicates a misunderstanding of discharge instructions. The client should already have a clear understanding of their prescribed medications before discharge, including dosage, timing, and purpose. This responsibility lies with the healthcare provider or nurse, not the pharmacy, and the nurse should provide additional clarification.
B. Verify that a follow-up appointment has been scheduled is appropriate and demonstrates that the client understands the importance of follow-up care to monitor recovery and address any complications.
C. Notify the healthcare provider (HCP) if a fever develops is a correct action, as fever may indicate infection, a common postoperative complication that requires prompt attention.
D. Use movement techniques taught by the physical therapists reflects proper understanding of postoperative mobility instructions, which are crucial for preventing complications such as blood clots and for supporting recovery.
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