A nurse is planning preoperative teaching for a client who is scheduled for a cholecystectomy. The client does not speak the same language as the nurse and is accompanied by her adolescent daughter. Which of the following actions should the nurse take?
Ask the client's daughter to interpret the conversation.
Talk loudly while facing the client.
Access a language line to interpret what is being said.
Use a bilingual dictionary to translate.
The Correct Answer is C
Choice A reason: Asking the client's daughter to interpret the conversation is not a correct action, as it may compromise the accuracy and confidentiality of the information. The nurse should not use family members or friends as interpreters, as they may have biases, emotions, or personal agendas that could interfere with the communication.
Choice B reason: Talking loudly while facing the client is not a correct action, as it may be perceived as rude or aggressive by the client. The nurse should not assume that the client can understand them better by increasing the volume or using gestures, as these may have different meanings in different cultures.
Choice C reason: Accessing a language line to interpret what is being said is the correct action, as it ensures that the communication is clear, accurate, and respectful. The nurse should use a qualified interpreter who is familiar with the medical terminology and the cultural context of the client.
Choice D reason: Using a bilingual dictionary to translate is not a correct action, as it may be time-consuming and ineffective. The nurse should not rely on a dictionary or a translation app, as they may not capture the nuances or expressions of the language. The nurse should also avoid using medical jargon or slang that may not be understood by the client.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Obtaining a prescription for a sedative for the client is not a correct action, as it may cause adverse effects such as confusion, falls, or respiratory depression. The nurse should avoid using sedatives unless absolutely necessary and use non-pharmacological interventions to calm the client.
Choice B reason: Removing the clock and calendar from the client's room is not a correct action, as it may worsen the client's disorientation and anxiety. The nurse should provide orientation cues such as a clock, a calendar, a radio, or a newspaper to help the client maintain a sense of time and reality.
Choice C reason: Providing distractions for the client during the day is a correct action, as it may reduce the client's boredom, agitation, and wandering behavior. The nurse should engage the client in meaningful activities such as music, games, crafts, or exercise that suit the client's interests and abilities.
Choice D reason: Raising all four side rails on the client's bed is not a correct action, as it may increase the risk of injury or entrapment if the client tries to climb over them. The nurse should use the least restrictive measures to prevent wandering, such as alarms, locks, or supervision.
Correct Answer is D
Explanation
Choice A reason: This is not the correct choice because this action is not the nurse's responsibility. Coordinating the team and the plan of care is the role of the case manager or the social worker, who can facilitate communication and collaboration among the different disciplines involved in the client's care.
Choice B reason: This is not the correct choice because this action is not the nurse's responsibility. Ordering durable medical equipment for the client's home is the role of the occupational therapist or the physical therapist, who can assess the client's functional needs and abilities and recommend the appropriate devices.
Choice C reason: This is not the correct choice because this action is not the nurse's responsibility. Helping the client obtain financial assistance is the role of the social worker or the financial counselor, who can identify the client's eligibility and options for funding and insurance coverage.
Choice D reason: This is the correct choice because this action is the nurse's responsibility. Performing a dietary assessment is part of the nursing process and the scope of practice of the nurse, who can evaluate the client's nutritional status and needs and provide education and counseling on diet modifications and interventions.
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