A nurse is caring for an adult client who has acute lymphocytic leukemia. The client is refusing blood products. Which of the following responses should the nurse make?
"Not receiving blood will slow down your recovery."
"I understand that you decided not to receive blood products."
"You need to talk with your doctor about this."
"Why are you refusing to receive blood products?"
The Correct Answer is B
Rationale:
A. This response is judgmental and may cause the client to feel guilty or defensive.
B. This response shows empathy and respect for the client's decision.
C. This response may be appropriate if the client needs further information or counseling but should not be the initial response.
D. This response is confrontational and may cause the client to become defensive.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Rationale for A: Providing oral care once every 8 hours is not directly related to relieving dyspnea. Oral care addresses comfort related to dry mouth, but it doesn't improve breathing difficulties.
Rationale for B: Repositioning the client every 4 hours can help alleviate dyspnea by improving lung expansion and preventing pooling of secretions. It also helps in reducing pressure injuries, promoting comfort, and preventing complications.
Rationale for C: Placing the head of the bed flat can exacerbate dyspnea by hindering lung expansion. It is recommended to elevate the head of the bed to improve air exchange and breathing.
Rationale for D: While using a fan can help with the sensation of breathlessness, repositioning every 4 hours is a more direct action to support ventilation and reduce dyspnea.
Correct Answer is B
Explanation
Rationale:
A. Moving the stronger leg forward before moving the weaker leg is incorrect and may increase the risk of falls.
B. Holding the cane on the stronger side provides support and stability while walking.
C. Moving the cane forward 18 inches is incorrect and may increase the risk of falls.
D. Wearing shoes with smooth soles may decrease traction and increase the risk of falls.
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