A nurse is caring for an older adult client who states, "I can't pay for my care because my kid took all my money." Which of the following actions should the nurse take?
Instruct the client to report the theft to the police
Report the possible abuse to adult protective services.
Ask the client if there is another family member they can call for financial help.
Restrict visitation for the client's family until discharge.
The Correct Answer is B
The nurse should report the possible abuse to adult protective services if an older adult client states that their child took all their money. This is an important nursing intervention to ensure the safety and well-being of the client.
a) Instructing the client to report the theft to the police may be appropriate, but it is not the first action the nurse should take. The nurse has a legal and ethical obligation to report suspected abuse to the appropriate authorities.
c) Asking the client if there is another family member they can call for financial help may be appropriate, but it does not address the issue of possible abuse.
d) Restricting visitation for the client's family until discharge is not appropriate and may violate the client's rights.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
b. "Everyone who lives in the home will need medication."
The nurse should inform the guardian that everyone who lives in the home will need medication when reinforcing teaching about enterobiasis. Enterobiasis, also known as pinworm infection, is highly contagious, and it can easily spread from person to person within the household. Treating only the affected individual may not be sufficient to eliminate the infection completely, as other household members may also be infected or at risk of reinfection.
Explanation for the other options:
a. "One dose of medication is all that will be necessary." Enterobiasis is typically treated with a medication regimen that involves taking multiple doses over a period of time. This is to ensure that all stages of the pinworm life cycle are targeted and eradicated. A single dose is usually not sufficient to eliminate the infection completely.
c. "Allow the child to take tub baths instead of showers." The choice of tub baths or showers does not directly impact the treatment or prevention of enterobiasis. Both methods of bathing can be used, but it is important to maintain good hygiene practices, such as regular handwashing and proper cleaning of the perianal area, to reduce the risk of reinfection.
d. "Wash all clothes and bed linens in cold water." While proper hygiene practices and laundering of clothes and bed linens are important in preventing the spread of enterobiasis, using cold water alone may not be sufficient. Washing clothes and bed linens in hot water (at a temperature of at least 60°C or 140°F) is recommended to kill any pinworm eggs that may be present.

Correct Answer is D
Explanation
When a mother states that she should have her baby latch on to both the nipple and areola during breastfeeding, it demonstrates an understanding of the correct latch technique. A proper latch involves the baby taking in not just the nipple but also a portion of the surrounding areola. This ensures effective milk transfer and helps prevent nipple soreness or damage.

"My baby should breastfeed 5 to 10 minutes on each breast": This statement is not entirely accurate. It is important to understand that breastfeeding duration can vary among infants, and there is no fixed timeframe for how long a baby should breastfeed on each breast. Some infants
may nurse for shorter periods, while others may take longer. The focus should be on ensuring that the baby is effectively nursing and getting enough milk rather than adhering strictly to a specific time limit.
"I should keep my baby on a strict feeding schedule": This statement is incorrect. Breastfeeding on demand, also known as responsive feeding, is generally recommended for newborns.
Newborns should be fed whenever they show signs of hunger, such as rooting, sucking motions, or increased alertness. Strict feeding schedules can interfere with the baby's natural feeding cues and hinder milk supply establishment.
"I should not wake my baby during the night to breastfeed": This statement is not accurate, especially for a 5-day-old newborn. Newborns typically need frequent feeding, including during the night, to meet their nutritional needs and support proper growth and development. It is generally recommended to wake a sleeping newborn every 2-3 hours during the night to ensure adequate feeding and prevent excessive weight loss.
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