A nurse is caring for a client who is scheduled for a surgical procedure and states, "I don't want to have this surgery anymore." Which of the following responses should the nurse make?

"You have the right to refuse the procedure."

"We can manage your care following the procedure without complications."

"Your doctor thinks this surgery is necessary."

"Let me review the procedure so you can understand what is going to happen."

Answer and Explanation

The Correct Answer is A

A. "You have the right to refuse the procedure.": Clients have the legal and ethical right to refuse treatment at any time, including surgery. Acknowledging this respects the client’s autonomy and supports informed decision-making.

B. "We can manage your care following the procedure without complications.": This statement minimizes the client’s concerns and may be perceived as coercive. It does not address the client’s right to make an informed choice.

C. "Your doctor thinks this surgery is necessary.": Referencing the provider’s opinion without exploring the client’s concerns does not respect the client’s autonomy and may increase anxiety or pressure to comply.

D. "Let me review the procedure so you can understand what is going to happen.": While providing information is helpful, the client has already expressed refusal. This approach may be more appropriate if the client is undecided, but it does not acknowledge their right to decline.

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Correct Answer is A

Explanation

A. "Since I retired, I have entered many gardening competitions.": Compensation involves emphasizing a strength or engaging in alternative activities to make up for perceived deficiencies or losses. Participating in competitions reflects the client redirecting energy to excel in another area, consistent with this defense mechanism.

B. "I'm so glad I've retired because the work was making me sick and depressed.": This statement reflects relief and rationalization rather than compensation, as the client is explaining the retirement in terms of health and well-being.

C. "There were lay-offs at my company, so I journaled about what I accomplished during my career.": Journaling is a coping strategy that promotes reflection and self-esteem, but it is more aligned with intellectualization or sublimation, not compensation.

D. "I had to retire because my boss didn't like me.": This statement demonstrates projection, attributing responsibility for a situation to someone else, rather than compensating for perceived loss or inadequacy.

A. Assist the family to establish a daily routine. B. Refer the family to a grief support group. C. Determine the roles of individual family members. D. Encourage the family to assign specific tasks to individual family members.

Correct Answer is C

Explanation

A. Assist the family to establish a daily routine: Establishing routines can provide structure, but it is more effective after the nurse has assessed the family’s current functioning and needs following the loss.

B. Refer the family to a grief support group: Referral to support groups is beneficial, but it is not the initial step. Understanding the family’s dynamics and coping capacity should precede external referrals.

C. Determine the roles of individual family members: Assessing each member’s role and function helps the nurse understand how the family is coping and identifies areas of strength and need. This assessment guides appropriate interventions and prioritizes support.

D. Encourage the family to assign specific tasks to individual family members: Assigning tasks is part of restoring structure, but it should follow an assessment of roles and capabilities to ensure tasks are appropriate and achievable.

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A nurse is caring for a client who is scheduled for a surgical procedure and states, "I don't want to have this surgery anymore." Which of the following responses should the nurse make?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is assessing the coping strategies of a client who has recently retired. Which of the following statements by the client indicates client is using compensation as a defense mechanism?

Correct Answer is A

Explanation

A community health nurse is working with a family that is struggling to adapt following the loss of a family member. Which of the following actions should the nurse take first?

Correct Answer is C

Explanation

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