A nurse is caring for a client who has acute lymphocytic leukemia. The client is refusing blood products. Which one of the following responses should the nurse take?
“I understand that you decided not to receive blood products.”
“Not receiving blood will slow down your memory”
“Why are you refusing to receive blood products?”
“You need to talk with your doctor about this”
The Correct Answer is A
Choice A Reason:
“I understand that you decided not to receive blood products.” This response shows empathy and acknowledges the client's decision without judgment. It respects the client's autonomy and decision-making capacity.
Choice B Reason:
“Not receiving blood will slow down your memory.” This statement introduces a potential consequence that may not be accurate or relevant to the client's decision. It is important to provide information, but scare tactics or inaccurate statements may not be helpful.
Choice C Reason:
“Why are you refusing to receive blood products?” While understanding the client's rationale is essential, the initial response should convey empathy and acceptance. Asking why may be appropriate later in the conversation, but starting with understanding is crucial.
Choice D Reason:
“You need to talk with your doctor about this.” While involving the doctor is important, it's essential to address the client's feelings and decisions directly. The nurse can play a supportive role in facilitating communication between the client and the healthcare team.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A Reason:
Lowering the side rail on the side of the bed where the AP will stand to perform mouth care is a safety measure. It provides better access to the client and allows the AP to perform the task more comfortably and effectively. This action helps prevent the AP from leaning over an elevated side rail, reducing the risk of injury to themselves or the client.
Choice B Reason:
Wearing clean gloves to perform mouth care for the client is a safety measure. Wearing gloves is crucial to maintain hygiene and prevent the transmission of microorganisms during mouth care.
Choice C Reason:
Using an oral care sponge swab moistened with cool water to clean the client's mouth is a safety measure. Using a moistened oral care sponge swab is a suitable method for providing mouth care to an unconscious client, helping to keep the mouth clean and moist.
Choice D Reason:
Using two gloved fingers to open the client's mouth for cleaning is NOT a safety measure. In this situation, using fingers to open the client's mouth poses a risk of injury or discomfort to the client. It's important to handle an unconscious patient's mouth with care and avoid using fingers to open the mouth forcibly.
Correct Answer is A
Explanation
Choice A Reason:
Allowing the family to participate in washing the client's body is appropriate. In Islamic tradition, it's customary for family members or individuals of the same gender to participate in washing the deceased's body. This practice is a part of the Islamic ritual of ghusl (ritual washing). It's respectful and important to honor the religious and cultural customs of the deceased and their family.
Choice B Reason:
Providing the family with an eagle feather for the client's hair is inappropriate. In Islamic traditions, the use of eagle feathers or any specific animal-related items isn't a part of postmortem care rituals. Additionally, incorporating items from other traditions or cultures might not align with the religious practices or beliefs of the deceased and their family.
Choice C Reason:
Encouraging the family to chant a mantra before moving the body is inappropriate. Chanting mantras isn't a practice in Islamic postmortem care. Islamic rituals involve specific prayers and actions according to the teachings of Islam, and chanting mantras isn't a part of this tradition.
Choice D Reason:
Dressing the client in a special amulet provided by the family is inappropriate. The use of amulets or charms isn't typically part of Islamic postmortem rituals. Islamic customs emphasize modesty in dress and following specific rites for the deceased, but incorporating special amulets or charms isn't a common practice.
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