A nurse is caring for a client who speaks a language different from the nurse. Which of the following actions should the nurse take?
Request an interpreter of a different sex from the client.
Request a family member or friend to interpret information for the client.
Direct attention toward the interpreter when speaking to the client.
Review the facility policy about the use of an interpreter
The Correct Answer is D
A. Request an interpreter of a different sex from the client. The interpreter's sex should be based on the client’s cultural preferences, not assumed by the nurse. This decision should be made to promote comfort and cultural sensitivity.
B. Request a family member or friend to interpret information for the client. This is not recommended, especially for medical discussions, as it may lead to misinterpretation, breaches of confidentiality, and biased communication.
C. Direct attention toward the interpreter when speaking to the client. The nurse should speak directly to the client, not the interpreter, to maintain a therapeutic relationship and respect for the client.
D. Review the facility policy about the use of an interpreter. This is the most appropriate initial action. Each facility typically has specific guidelines and procedures for accessing qualified medical interpreters, which the nurse should follow to ensure accurate and ethical communication.
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Related Questions
Correct Answer is C
Explanation
A. 0.45% saline. This is a hypotonic solution, which may be used later in diabetic ketoacidosis (DKA) management, but it is not appropriate for initial fluid resuscitation as it does not rapidly expand intravascular volume.
B. NPH insulin. NPH is an intermediate-acting insulin and is not used for continuous infusion. In DKA, rapid insulin correction is needed, typically with a short-acting insulin like regular insulin.
C. 0.9% normal saline. This isotonic fluid is the first-line choice for fluid replacement in clients with DKA. It helps restore circulating volume and correct dehydration quickly, which is a critical initial intervention.
D. Glargine insulin. Glargine is a long-acting insulin and not suitable for IV infusion. DKA requires the use of short-acting insulin (e.g., regular insulin) administered via IV infusion to correct hyperglycemia and acidosis.
Correct Answer is C
Explanation
A. "You will feel your baby moving within the next month." Fetal movement, or quickening, is typically felt between 16 and 20 weeks of gestation. At 9 weeks, it is too early for the client to detect fetal movement.
B. "Hormone shifts often cause vulvar itching." Vulvar itching is not a common or expected symptom of early pregnancy and may indicate an infection, such as a yeast infection, rather than a normal hormonal change.
C. "You should consume at least 3 liters of fluid each day." Adequate hydration is essential during pregnancy to support increased blood volume, amniotic fluid, and metabolic processes. A daily intake of about 3 liters of fluid helps prevent dehydration and constipation.
D. “Headaches are expected throughout pregnancy." While headaches can occur, especially in the first trimester due to hormonal changes, persistent or severe headaches may indicate complications like preeclampsia and should not be considered a normal, ongoing expectation.
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