A home health nurse is conducting an initial home visit for a client who has terminal breast cancer. The client has two school-age children and a limited support system. Which of the following is the priority nursing action?
Inform the client of available community resources.
Assist the client in finding child care options.
Agree upon short-term goals for the client.
Ask the client about their understanding of the diagnosis.
The Correct Answer is D
A. Inform the client of available community resources is an important action because the client will likely need additional support, such as hospice care, counseling, or child care services. However, before providing resources, the nurse must assess the client’s understanding of their diagnosis to ensure any interventions are tailored to their current needs and readiness.
B. Assist the client in finding child care options - While important, addressing community resources takes precedence as it may encompass finding child care options as well.
C. Agree upon short-term goals for the client - Establishing goals is important but may come after addressing immediate needs.
D. Ask the client about their understanding of the diagnosis is the priority action. Before any other interventions, the nurse must assess the client’s knowledge and perception of their condition. This foundational step allows the nurse to provide appropriate education, clarify any misconceptions, and ensure that all care planning aligns with the client’s needs, values, and readiness to engage in discussions about their care.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Brushing teeth immediately after eating may exacerbate nausea, especially if the client is experiencing pregnancy-related nausea and vomiting.
B. Laying down for 30 minutes after meals may worsen nausea and reflux symptoms.
C. Drinking 12 oz of water with each meal may contribute to feelings of fullness and exacerbate nausea and vomiting.
D. Eating a dry carbohydrate before getting out of bed, such as crackers or dry toast, can help alleviate nausea and vomiting associated with pregnancy by providing a bland, easily digestible source of energy before the client starts moving in the morning.
Correct Answer is B
Explanation
A. While creating a flexible daily schedule may be helpful, it does not directly address the core symptoms of OCD.
B. Gradually decreasing the time allowed for ritualistic behavior is a common technique used in exposure and response prevention therapy, which is an evidence-based treatment for OCD.
C. Offering solutions for problem-solving may be helpful in general, but it may not directly address the specific symptoms of OCD.
D. While meditation can be beneficial for managing stress and anxiety, it may not specifically address the compulsive thoughts and behaviors characteristic of OCD.
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