A nurse is assisting with the care of a client who has a recent diagnosis of a chronic condition and is exhibiting findings of ineffective coping. Which of the following actions should the nurse take first?

Determine if the client has a support system.

Schedule a mental health consult for the client.

Provide the client with information about coping strategies.

Encourage the client to attend a support group.

Answer and Explanation

The Correct Answer is A

A)   Determine if the client has a support system. - Assessing the client's current support network is essential to determine available resources and potential interventions.
B)   Schedule a mental health consult for the client. - While mental health support may be necessary, understanding the client's existing support system is the first step.
C)   Provide the client with information about coping strategies. - Providing coping strategies is important but should come after assessing the client's support system.

D)   Encourage the client to attend a support group. - Encouraging attendance at support groups can be helpful, but it's important to assess the client's current support system first.

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Correct Answer is A

Explanation

A. "He is here in the hospital, but I cannot tell you anything else."- This response respects the client's confidentiality and does not disclose protected health information to unauthorized individuals.

B. "I cannot confirm or deny that we have a client by that name."- This response is evasive and does not provide any useful information.
C. "The client's condition is stable right now."- Disclosing the client's condition without their consent is a violation of confidentiality.
D. "I will tell him you called."- This response breaches the client's confidentiality by confirming their presence in the hospital.

A. Place the specimen in a clean specimen cup. B. Clamp the catheter tubing below the needleless port. C. Clamp the catheter tubing for 60 min. D. Remove 45 mL of urine from the catheter with a syringe.

Correct Answer is B

Explanation

A) Place the specimen in a clean specimen cup. - Urine collected from an indwelling urinary catheter should be obtained using a sterile technique, not placed directly into a clean specimen cup.
B) Clamping the catheter tubing for 10–30 minutes before collecting the sample allows fresh urine to accumulate in the tubing, ensuring a more accurate culture result. The urine should be collected from the designated port using aseptic technique, not from the catheter bag, as stagnant urine may contain contaminants.

C) Clamp the catheter tubing for 60 min. - Clamping the tubing for an extended period can cause urinary retention and discomfort for the client. It is not appropriate for collecting a urine specimen.
D) Only 3–5 mL of urine is needed for a culture.The nurse should collect the appropriate small amount to avoid unnecessary removal of urine.

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A nurse is assisting with the care of a client who has a recent diagnosis of a chronic condition and is exhibiting findings of ineffective coping. Which of the following actions should the nurse take first?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse on a medical-surgical unit receives a telephone call from an individual who identifies himself as the client's employer. The employer asks the nurse about the client's condition. Which of the following is an appropriate response by the nurse?

Correct Answer is A

Explanation

A nurse is collecting a urine specimen for culture and sensitivity from a client who has an indwelling urinary catheter. Which of the following actions should the nurse take?

Correct Answer is B

Explanation

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