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The nurse makes a home visit to a client with chronic kidney disease. The client asks the nurse to make the decision about whether or not to start dialysis. Which action by the nurse is most appropriate?
- A. Encourage the client to appoint a durable power of attorney.
- B. Invite the client to make a decision after reviewing options.
- C. Direct the client to have the physician make a decision.
- D. Have the client visit with an individual receiving dialysis.
Correct Answer: B
Rationale: Step 1: The nurse should respect the client's autonomy and involve them in decision-making.
Step 2: By inviting the client to make a decision after reviewing options, the nurse promotes client-centered care.
Step 3: This approach empowers the client to participate actively in their healthcare decisions.
Step 4: It aligns with ethical principles of beneficence and nonmaleficence.
Summary:
Choice B is correct as it respects the client's autonomy and promotes shared decision-making. Choice A is not appropriate as it bypasses the client's involvement. Choice C is not ideal as the client should be actively involved. Choice D may provide information but doesn't involve the client in decision-making.
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Behaviors that indicate to the patient that the nurse is inattentive to the patient's concerns are such activities as: (Select all that apply.)
- A. turning back to straighten the bedside table while the patient is talking.
- B. tapping feet or fingers.
- C. sitting down in a chair near the bed with arms crossed.
- D. leaving a hand on the door to go out.
Correct Answer: A
Rationale: The correct answer, A, is turning back to straighten the bedside table while the patient is talking. This behavior indicates the nurse is not fully engaged in the conversation and prioritizing a task over the patient. Tapping feet or fingers (B) could just be a habit and may not necessarily indicate inattentiveness. Sitting down with arms crossed (C) could be a sign of being defensive but not necessarily inattentive. Leaving a hand on the door (D) could be a signal of readiness to leave but not a direct indicator of inattentiveness.
A patient asks the nurse to make a decision for her about whether or not to continue taking hormone replacement therapy (estrogen). Which response by the nurse is most appropriate?
- A. "You should check with a doctor; I cannot give you advice about drugs."
- B. "My friend has taken estrogen for more than 5 years without any problems."
- C. "I can answer any questions you have but it is up to you to make this decision."
- D. "Herbal supplements were much better for me than prescription-strength estrogen."
Correct Answer: C
Rationale: The correct answer is C because it emphasizes patient autonomy and informed decision-making, aligning with ethical principles. The nurse should not make decisions for the patient but should provide information and support. Choice A deflects responsibility and does not empower the patient. Choice B is anecdotal and not a reliable source of information. Choice D is not relevant to the patient's question and could potentially lead to misinformation. Ultimately, choice C encourages the patient to take an active role in their healthcare decisions, which promotes patient-centered care.
According to the NCSBN, appropriate self-disclosure is a part of maintaining professional boundaries. Appropriate self-disclosure includes the following:
- A. Discussing intimate or personal values with patients
- B. Keeping secrets with a patient or for a patient
- C. Expressing you are the only one who truly understands patient
- D. Brief, focused, and only used if experience is similar
Correct Answer: D
Rationale: The correct answer is D because appropriate self-disclosure in a therapeutic setting should be brief, focused, and only shared if it enhances the therapeutic relationship. This helps maintain professional boundaries and keeps the focus on the patient's needs. Choice A is incorrect because discussing intimate or personal values with patients can blur boundaries and shift the focus away from the patient. Choice B is incorrect because keeping secrets with or for a patient can lead to ethical dilemmas and compromise trust. Choice C is incorrect because expressing that you are the only one who truly understands the patient can create a power imbalance and hinder the therapeutic process.
When a patient begins crying during a conversation with the nurse about the patient's upcoming surgery for possible malignancy, the nurse's most therapeutic response would be:
- A. "Your surgeon is excellent, and I know he'll do a great job."
- B. "Oh, dear, your gown is way too big, let me get you another one."
- C. "Don't cry; think about something else and you'll feel better."
- D. "Here is a tissue. I'd like to sit here for a while if you want to talk."
Correct Answer: D
Rationale: The correct answer is D. This response acknowledges the patient's emotions, offers support, and provides an opportunity for the patient to express their feelings. Offering a tissue shows empathy and readiness to listen. Sitting with the patient shows availability and willingness to engage further. This response validates the patient's emotions and fosters a therapeutic nurse-patient relationship.
Choice A is incorrect because it dismisses the patient's emotions and focuses on the surgeon rather than the patient. Choice B is incorrect as it ignores the patient's emotional distress and focuses on a non-essential issue. Choice C is incorrect as it invalidates the patient's feelings and suggests avoidance rather than addressing the emotions directly.
The nurse is reviewing Mr. N's (non-Hodgkin lymphoma) medication administration record and sees that the combination therapy aprepitant, dexamethasone, and ondansetron was administered during the last shift. What is the nurse most likely to ask to determine efficacy of the therapy?
- A. "On a scale of 1 to 10, with 1 being the least and 10 being the worst, what number is your pain? Where is the pain located?"
- B. "Have the medications improved your appetite? Are there special foods that you would prefer?"
- C. "Are you having any feelings of nausea right now? When was the last time you vomited?"
- D. "After taking the medications, have you experienced any improvement in your energy level? Do you feel fatigued?"
Correct Answer: C
Rationale: The correct answer is C. The nurse would ask about feelings of nausea and vomiting to determine the efficacy of the antiemetic therapy. Nausea and vomiting are common side effects of chemotherapy, which Mr. N would receive for non-Hodgkin lymphoma. Improvement in these symptoms indicates the effectiveness of the antiemetic regimen. Choices A, B, and D are not directly related to the medications administered and would not provide valuable information on the efficacy of the therapy for managing chemotherapy-induced nausea and vomiting. Option A focuses on pain assessment, B on appetite and food preferences, and D on energy levels and fatigue, which are not the primary outcomes to evaluate in this context.