A nurse is administering oral sedative to a client who is receiving care following an involuntary admission. The client states, "I'm not taking any more medication." Which of the following actions should the nurse perform?
Refer the case to the facility's ethics committee.
Document the client's refusal of the medication in the medical record.
Administer the medication by another route.
Inform the client that due to her involuntary admission, she cannot refuse a sedative.
The Correct Answer is B
Choice A reason: Referring the case to the ethics committee is not the immediate action required.
Choice B reason: The correct answer is b) because documenting the client's refusal ensures that it is noted in the medical record and appropriate follow-up actions can be taken.
Choice C reason: Administering the medication by another route without consent is not appropriate.
Choice D reason: Informing the client that she cannot refuse medication due to involuntary admission is not accurate; clients retain certain rights even when involuntarily admitted.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Focusing on the bad things does not support cognitive reframing, which aims to find positive aspects or learning experiences.
Choice B reason: The correct answer is b) because cognitive reframing involves looking at situations from a different perspective, focusing on what can be learned and how it can be used positively in the future.
Choice C reason: Asking about prior relationships does not address the client's statement about the marriage.
Choice D reason: Stating that only the client can understand the impact does not support cognitive reframing.
Correct Answer is C
Explanation
Choice A reason: Remaining with the client while family members visit is appropriate for ensuring safety.
Choice B reason: Asking for assistance during lunch is appropriate to maintain continuous observation.
Choice C reason: The correct answer is c) because leaving the client alone to ambulate the roommate indicates that the LPN is not maintaining constant observation, which is crucial for suicide precautions.
Choice D reason: Accompanying the client to therapy ensures continuous observation and is appropriate.
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