A client with life-threatening injuries from a gunshot wound to the abdomen is mechanically ventilated and sedated. The client has a large family present who are asking multiple and repetitive questions. Which intervention should the nurse implement first?
Let each family member ask a question one at a time.
Request the healthcare provider to speak with the family.
Ask the family to identify a specific spokesperson.
Page a chaplain on call to be present for questions.
The Correct Answer is C
A) This intervention is not the best because it may take too much time and energy from the nurse, who needs to focus on the client's critical condition. The nurse may also have to repeat the same information multiple times, which can be frustrating and confusing for both the nurse and the family.
B) This intervention is not the best because it may not be feasible or appropriate at this time. The healthcare provider may be busy with other clients or procedures, and may not be able to speak with the family right away. The healthcare provider may also need to obtain the client's consent or permission before disclosing any information to the family, which may not be possible if the client is sedated.
C) This intervention is the best because it can help reduce the number and frequency of questions, and facilitate clear and consistent communication between the nurse and the family. The nurse can ask the family to choose one person who will act as their representative and spokesperson, and who will relay any information or updates to the rest of the family. This can also help respect the client's privacy and confidentiality, and prevent any conflicting or contradictory messages.
D) This intervention is not the best because it may not address the family's informational needs or preferences. The chaplain on call may provide spiritual or emotional support to the family, but may not be able to answer any medical or technical questions. The family may also have different religious or cultural beliefs that may not align with the chaplain's role or perspective.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A Reason: Announcing the new plan at a special employee wellness event may be a good way to promote the plan and celebrate the achievement, but it is not the most important action. The nurses working on the committee should first communicate the plan to their colleagues and address any questions or concerns they may have.
Choice B Reason: Determining staff opinion of current healthcare insurance costs may be useful for evaluating the need and feasibility of the new plan, but it is not the most important action. The nurses working on the committee should have done this before developing and approving the new plan, not after.
Choice C Reason: Surveying the nurses to see who wants to keep the old benefits plan may be helpful for assessing the satisfaction and acceptance of the new plan, but it is not the most important action. The nurses working on the committee should have considered the preferences and needs of their colleagues during the development and approval of the new plan, not after.
Choice D Reason: Being available to all shifts to discuss the changes in health benefits is the most important action for the nurses working on the committee to implement, as it shows respect and transparency for their colleagues, and fosters a collaborative and supportive work environment. The nurses working on the committee should explain the rationale and benefits of the new plan, and provide feedback and guidance to their colleagues.
Correct Answer is B
Explanation
Choice A Reason: Beginning initial sterile wound care for surgical clients is a nursing intervention that requires clinical judgment and cannot be delegated to the PN. The PN may assist with wound care after the initial dressing change, but the RN is responsible for assessing the wound and initiating the plan of care.
Choice B Reason: Validating prescribed intravenous flow rates is a routine task that does not require clinical judgment and can be delegated to the PN. The PN has the knowledge and skill to check the IV orders, calculate the drip rate, and monitor the infusion.
Choice C Reason: Determining the need for urinary catheterizations is a nursing assessment that requires clinical judgment and cannot be delegated to the PN. The PN may perform urinary catheterizations as ordered by the physician, but the RN is responsible for evaluating the indication, risk, and benefit of the procedure.
Choice D Reason: Receiving a postoperative client and conducting the assessment is a nursing intervention that requires clinical judgment and cannot be delegated to the PN. The RN is responsible for receiving reports from the operating room, assessing the client's status, identifying potential complications, and initiating the plan of care.
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