A patient without health insurance comes into the Emergency department limping and dripping blood from a head wound. Which of the following should be done first for this patient?
Determine triage level and examine and stabilize as needed.
Give the patient information about facilities that specialize in treating people without health insurance.
Ask the patient to sign in and provide method of payment for services.
Transfer the patient to a hospital that specializes in traumatic brain injuries.
The Correct Answer is A
The nurse should determine the patient's triage level and examine and stabilize the patient as needed when caring for a patient without health insurance who is limping and dripping blood from a head wound in the Emergency department. This intervention is the priority because the patient could be at risk of life-threatening complications if their condition is left untreated. Giving the patient information about facilities that specialize in treating people without health insurance, choice B, and asking the patient to sign in and provide method of payment for services, choice C, may be necessary but are not the priority at this time. Transferring the patient to a hospital that specializes in traumatic brain injuries, choice D, may be necessary after stabilizing the patient, but it is not the priority at this time.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Answer: A. "It sounds like you're having a difficult time."
Rationale:
A) "It sounds like you're having a difficult time":
This response is empathetic and acknowledges the client's distress. By validating the client's feelings, the nurse provides support and opens the door for further discussion about their anxiety and related symptoms. This approach can help the client feel understood and encourage them to share more about their experience.
B) "Have you talked to your provider about this yet?":
While it is important for the client to communicate their symptoms to their provider, this response might come across as dismissive of the client's immediate emotional state. It could be more supportive to first acknowledge the client's current experience before suggesting further actions.
C) "Everyone has trouble sleeping at times":
This response may minimize the client's concerns and fail to address their specific experience. It can come off as invalidating by suggesting that their situation is normal and not warranting further exploration or support.
D) "Why do you think you are so anxious?":
Asking why the client feels anxious might be perceived as interrogative rather than supportive. This approach could put pressure on the client to explain their feelings, which might not be productive if they are struggling to articulate their emotions or causes of anxiety.
Correct Answer is ["C","E"]
Explanation
"I call a friend who makes me smile and laugh," and "I tense and release my muscles, starting with my feet." These are adaptive coping strategies that help to reduce stress and promote relaxation. Calling a friend who makes you smile and laugh, for example, can help to distract from negative thoughts and promote positive emotions. Tense and release exercises can help to reduce muscle tension and promote relaxation.
Choice A, "I sleep in in the mornings," is not an adaptive coping strategy because it doesn't address the source of stress and may actually lead to avoidance.
Choice B, "I isolate myself in my room for a few hours when things get overwhelming," is not adaptive because it promotes social withdrawal and avoidance.
Choice D, "I think about being on my favorite beach vacation," is not adaptive because it promotes avoidance and doesn't address the source of stress.
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