14) A nurse is preparing to discharge a client who has end- stage heart failure. the client's partner tells the nurse she can no longer handle caring for the client. which of the following actions should the nurse take?

Ask the provider to delay the client's discharge home for a few more days.

Recommend the partner place the client in a long- term care facility.

Contact the case manager to discuss discharge options.

Request another family member assist the client's partner with care.

Answer and Explanation

The Correct Answer is C

a.   Delaying the client's discharge without exploring other options may not address the partner's concerns and could lead to further issues.
b.   While placing the client in a long-term care facility may be an option, it should be discussed with the case manager and considered alongside other options.
c.   Contacting the case manager is appropriate to discuss the partner's concerns and explore alternative discharge arrangements that meet the client's needs.
d.   Requesting another family member to assist may not be feasible or address the partner's ability to provide care.

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Correct Answer is C

Explanation

A. A client with active bleeding from a puncture wound to the groin area requires immediate attention; however, the priority is determined by assessing the severity and potential complications associated with each condition.

B. A raised red skin rash could indicate an allergic reaction or infection, but it is not life-threatening compared to respiratory distress.

C. A client who reports shortness of breath and left shoulder and neck pain is the highest priority because these symptoms can indicate a serious condition, such as a myocardial infarction or pulmonary embolism. Both conditions require urgent assessment and intervention to prevent deterioration.

D. Right-sided flank pain can indicate kidney stones or other issues but is less critical than the risk of respiratory compromise present in option C.

A. Ask the client if she would like a sedative to help her relax B. Inform the client that she cannot leave without a discharge prescription from the provider C. Have the client sign the Against Medical Advice form D. Assign a security officer to the client's room until the provider can speak with the client

Correct Answer is C

Explanation

. Inform the client that she cannot leave without a discharge prescription from the provider

Rationale:
a. Offering a sedative may not address the client's concerns and is not an appropriate response to the situation.
b.Inform the client that she cannot leave without a discharge prescription from the provider. Clients have the right to leave against medical advice; informing them otherwise infringes on their rights.

C Have the client sign the Against Medical Advice form. This action respects the client's autonomy while ensuring documentation of her decision to leave against medical advice, which protects both the client and healthcare facility legally.

d. Assigning a security officer to the client's room may escalate the situation unnecessarily. The focus should be on communication and education.

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14) A nurse is preparing to discharge a client who has end- stage heart failure. the client's partner tells the nurse she can no longer handle caring for the client. which of the following actions should the nurse take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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