A son brings his elderly mother to the emergency department and states that she fell today. The nurse notes multiple bruises in all stages of healing all over the client’s body. Which action should the nurse take first?.
Provide an elder abuse brochure and teach the client.
Interview the client privately and ask if anyone is harming her.
Observe the interaction between the mother and the son throughout stay.
Report the abuse without confirming
The Correct Answer is B
Interview the client privately and ask if anyone is harming her.
This is because the nurse has a duty to assess the client for possible elder abuse and report any suspicions to the appropriate authorities.
The nurse should not assume that the son is the abuser or that the client will disclose the abuse without being asked directly.
The nurse should also respect the client’s autonomy and privacy and not confront the son or provide an elder abuse brochure without the client’s consent.
Choice A is wrong because it may imply that the client is responsible for preventing the abuse or that the nurse has already made a judgment about the situation.
It may also be ineffective if the client is unable or unwilling to read the brochure or seek help. Choice C is wrong because it may delay the assessment and intervention for the client.
It may also be biased and unfair to observe the son without interviewing him or the client first.
Choice D is wrong because it may violate the client’s rights and preferences.
It may also be premature to report the abuse without confirming it with the client or obtaining more evidence.
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Correct Answer is D
Explanation
“I feel uncomfortable praying with you, but I will find someone who won’t feel that way.” This statement by the nurse would best meet the client’s spiritual needs because it acknowledges the nurse’s own boundaries and feelings while also respecting the client’s request and finding a way to fulfill it.
Some possible explanations for why the other choices are wrong are:
Choice A is wrong because it does not address the client’s request to pray together and it assumes that the client wants a Bible without asking.
Choice B is wrong because it implies that the nurse does not want to pray with the client and that the client’s visitors would be more suitable for this task, which could make the client feel rejected or unsupported.
Choice C is wrong because it directly rejects the client’s request and discloses the nurse’s personal beliefs, which could create a sense of disconnection or conflict between the nurse and the client.
Correct Answer is C
Explanation
A two-hour postprandial glucose test is done to check your blood sugar level two hours after you eat a meal.
This test helps to diagnose diabetes or monitor its treatment. A normal blood sugar level for this test is less than 140 mg/dL.
Choice A is wrong because fasting means not eating for at least eight hours before the test. This is done for a fasting blood glucose test, not a postprandial one.
Choice B is wrong because before breakfast means before you eat anything in the morning. This is also done for a fasting blood glucose test, not a postprandial one.
Choice D is wrong because before glucose is consumed means before you drink a sugary liquid for a glucose tolerance test. This test measures how your body handles glucose after drinking it, not after eating a meal.
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