A community health nurse is performing a home health admissions assessment with a client. The client reports being unable to obtain their prescriptions. Which of the following actions should the nurse take first?
Notify the client's family member regarding their inability to obtain prescriptions.
Call the local pharmacist on behalf of the client.
Assess the barriers to the client's ability to obtain prescriptions.
Initiate a referral to a social worker.
The Correct Answer is C
Rationale:
A. Notify the client’s family member regarding their inability to obtain prescriptions: Involving family members can be helpful later, but the nurse must first understand why the client cannot obtain medications before deciding whether family assistance is necessary.
B. Call the local pharmacist on behalf of the client: Contacting the pharmacist may help resolve access issues such as refills or delivery, but this step is premature without identifying the specific barriers that prevent the client from getting medications.
C. Assess the barriers to the client’s ability to obtain prescriptions: The first action is assessment to determine the root cause of the problem. Barriers may include lack of transportation, financial hardship, limited mobility, or misunderstanding of the prescription process. Once the cause is identified, appropriate interventions or referrals can be made.
D. Initiate a referral to a social worker: A social worker can assist with financial or community resources, but the nurse should first gather assessment data to provide accurate information for an effective referral.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Rationale:
A. Instruct the client’s partner to assume care of the colostomy for the client: Having the partner take over care may reinforce the client’s avoidance and hinder acceptance of the stoma. The goal is to promote gradual involvement and self-care.
B. Encourage the client and partner to avoid expressing negative feelings about the colostomy: Suppressing emotions can delay psychological adjustment. The nurse should instead encourage open discussion of feelings.
C. Transfer the client to a rehabilitation facility for instruction about self-management of the colostomy: Transferring the client is unnecessary at this stage and may add emotional stress. Education and emotional support can be effectively provided in the current care setting.
D. Suggest the client join a support group for people who have colostomies: Support groups provide opportunities to share experiences with others who have undergone similar surgeries. Peer support can reduce isolation, promote acceptance, and help the client adapt to lifestyle changes more confidently.
Correct Answer is C
Explanation
Rationale:
A. After inflation, deflate a blood pressure cuff on the client's arm while palpating their brachial pulse: This technique assesses blood pressure, not pulse deficit. Pulse deficit requires comparing simultaneous heartbeats at different sites rather than using a cuff for measurement.
B. Compare the client's carotid pulse while resting to their carotid pulse after standing for 1 min: This evaluates orthostatic changes in heart rate, not pulse deficit. Pulse deficit specifically identifies a difference between apical and peripheral pulses during the same cardiac cycle.
C. Measure the client's apical pulse while another nurse measures their radial pulse: A pulse deficit is determined by counting the apical pulse and comparing it to the radial pulse simultaneously. A difference indicates that some heartbeats are not producing a palpable peripheral pulse, which is important in conditions like atrial fibrillation.
D. Assess both of the client's radial pulses at the same time and compare the quality of pulsations: Comparing radial pulses on both sides evaluates for peripheral pulse equality or arterial obstruction, not pulse deficit.
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