The nurse is performing a psychosocial assessment on a client with severe rheumatoid arthritis. What would be the most appropriate statement by the nurse?
"Tell me about what medications you are taking."
"What physical limitations are you experiencing?"
"How does this impact your role in your family?"
"What therapies are you using to reduce swelling?"
The Correct Answer is C
Choice A reason: "Tell me about what medications you are taking." is not the most appropriate statement by the nurse, because it is not related to the psychosocial assessment. Medications are part of the physical or pharmacological assessment, which focuses on the type, dose, frequency, and effectiveness of the drugs that the client is taking for rheumatoid arthritis. Medications may have some psychosocial implications, such as side effects, costs, or adherence, but they are not the main focus of the psychosocial assessment.
Choice B reason: "What physical limitations are you experiencing?" is not the most appropriate statement by the nurse, because it is not related to the psychosocial assessment. Physical limitations are part of the functional or mobility assessment, which focuses on the range of motion, strength, endurance, and coordination of the joints and muscles that are affected by rheumatoid arthritis. Physical limitations may have some psychosocial implications, such as pain, disability, or dependence, but they are not the main focus of the psychosocial assessment.
Choice C reason: "How does this impact your role in your family?" is the most appropriate statement by the nurse, because it is related to the psychosocial assessment. Role in the family is part of the social or relational assessment, which focuses on the interactions, responsibilities, and expectations of the client and their family members in relation to rheumatoid arthritis. Role in the family may have significant psychosocial implications, such as role changes, role conflicts, role strain, or role loss, which can affect the client's selfesteem, identity, and coping.
Choice D reason: "What therapies are you using to reduce swelling?" is not the most appropriate statement by the nurse, because it is not related to the psychosocial assessment. Therapies are part of the physical or nonpharmacological assessment, which focuses on the modalities, techniques, or devices that the client is using to manage the symptoms of rheumatoid arthritis. Therapies may have some psychosocial implications, such as availability, accessibility, or preference, but they are not the main focus of the psychosocial assessment.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason: Postponing daily bed bath is not appropriate for reducing the risk of a friction and shear injury. Bed bath is a hygiene measure that helps to keep the skin clean and dry and prevent infection. Friction and shear are caused by the rubbing and pulling of the skin against the bed surface, not by the bed bath itself.
Choice B reason: Elevating the client’s head of the bed to 45 degrees is not appropriate for reducing the risk of a friction and shear injury. In fact, this may increase the risk as the client may slide down the bed due to gravity and cause more friction and shear on the skin. The head of the bed should be kept at the lowest possible angle, preferably less than 30 degrees, unless contraindicated by the client’s condition.
Choice C reason: Caregiver independently slides the client up in bed is not appropriate for reducing the risk of a friction and shear injury. This may cause more damage to the skin as the caregiver may exert excessive force and drag the client’s skin along the bed surface. The caregiver should use a draw sheet or a slide board to lift and reposition the client with the help of another person.
Choice D reason: Use a mechanical lift to reposition the client every 2 hours is the most appropriate intervention for reducing the risk of a friction and shear injury. A mechanical lift is a device that helps to transfer and reposition the client safely and comfortably. It reduces the friction and shear on the skin by lifting the client off the bed surface and avoiding any sliding or dragging. It also prevents the caregiver from injuring themselves by lifting the client manually. The client should be repositioned every 2 hours to relieve the pressure on the skin and prevent pressure ulcers.
Correct Answer is B
Explanation
Choice A reason: "You should never go around people after your baby is born." is not a good response, because it is unrealistic, rigid, and dismissive of the mother's concern. It does not acknowledge the benefits of social interaction and support for the mother and the baby, nor the risks of isolation and depression. It also does not provide any evidence or rationale for the advice.
Choice B reason: "Tell me more about that." is the best response, because it is openended, empathetic, and respectful of the mother's concern. It invites the mother to share her feelings and thoughts, and allows the nurse to explore the source and extent of the mother's anxiety. It also creates an opportunity for the nurse to provide education and reassurance based on the mother's needs.
Choice C reason: "I did that, and my kids turned out just fine." is not a good response, because it is personal, irrelevant, and unprofessional. It does not address the mother's concern, but rather shifts the focus to the nurse's own experience, which may not be applicable or helpful to the mother. It also implies that the mother's concern is unfounded or exaggerated, and may make the mother feel judged or defensive.
Choice D reason: "Why do you think that is a bad idea?" is not a good response, because it is closedended, confrontational, and accusatory. It does not show empathy or respect for the mother's concern, but rather challenges or criticizes it. It may make the mother feel defensive or guilty, and may discourage further communication.
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