After bilateral knee replacement surgery, an elderly client wants to go to a rehabilitation facility for additional physical therapy. That facility refuses to admit this client for insurance reasons. The nurse then calls the insurance company and strongly explains why this client needs to go to a rehabilitation facility. This is an example of:

responsibility.

confidentiality.

social justice.

advocacy

Answer and Explanation

The Correct Answer is D

A. Responsibility: Responsibility refers to the duty or obligation to fulfill one's role or tasks appropriately. While advocating for the client may be considered a responsibility of the nurse, the specific action described in the scenario—calling the insurance company to strongly explain the client's need for rehabilitation—is more accurately categorized as advocacy.

B. Confidentiality: Confidentiality pertains to protecting the privacy and confidentiality of patient information. The scenario does not involve the disclosure of confidential information but rather advocating for the client's needs regarding their rehabilitation placement.

C. Social justice: Social justice involves promoting fairness, equality, and equitable access to resources and opportunities for all members of society. While advocating for the client may align with principles of social justice, the specific action described in the scenario—calling the insurance company to argue for the client's rehabilitation placement—is more directly related to individual advocacy rather than addressing broader societal inequalities.

D. Advocacy: Advocacy refers to actively supporting and speaking up for the rights, needs, and interests of others. In this scenario, the nurse advocates for the elderly client by calling the insurance company to strongly explain why the client needs to go to a rehabilitation facility despite the facility's refusal. This action demonstrates the nurse's commitment to ensuring the client receives appropriate care and support.

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Correct Answer is B

Explanation

A. Asking the client to bear down as if urinating: This action is not appropriate in this situation because the lack of urine output may not necessarily be due to the client's inability to void. Checking for other potential issues, such as kinks in the tubing, is more appropriate as a first step.

B. Check for kinks in the tubing: This is the most appropriate first action. Kinks in the tubing can obstruct urine flow from the bladder to the drainage bag, leading to decreased or no urine output. By checking for kinks, the nurse can quickly identify and correct any obstructions, potentially resolving the issue without further intervention.

C. Increasing fluid intake: While maintaining adequate hydration is important for overall urinary function, it is not the most immediate action needed when there is no urine output in the catheter bag. Addressing potential mechanical issues, such as kinks in the tubing, takes precedence.

D. Inserting a new indwelling urinary catheter: Inserting a new catheter should not be the first action taken without investigating other potential causes for the lack of urine output. It is important to troubleshoot and address possible issues with the current catheter and drainage system before considering catheter replacement.

A. "I can take this medication along with mineral oil." B. "I should drink 4 ounces of water when I take the medication." C. "It might take up to 3 days for the medication to work." D. "I will take the medication for diarrhea."

Correct Answer is C

Explanation

Docusate sodium is a stool softener commonly prescribed to alleviate constipation, particularly in patients taking opioid pain medications, which often cause constipation as a side effect. When educating a client about docusate sodium, it's essential to provide accurate information about its onset of action and expected effects.

A. "I can take this medication along with mineral oil."

This statement indicates a misunderstanding of the teaching. Combining docusate sodium with mineral oil is not recommended because mineral oil can interfere with the absorption of fat-soluble vitamins and may diminish the effectiveness of docusate sodium.

B. "I should drink 4 ounces of water when I take the medication."

Although it's important to stay hydrated when taking docusate sodium, there isn't typically a specific volume of water recommended for each dose. While hydration can aid in the effectiveness of the medication, this statement doesn't directly address the expected action of docusate sodium.

C. "It might take up to 3 days for the medication to work."

This statement demonstrates an understanding of the teaching. Docusate sodium may take a few days to produce a noticeable effect on bowel movements. Understanding this timeline helps manage the client's expectations and prevents premature discontinuation of the medication due to perceived lack of efficacy.

D. "I will take the medication for diarrhea."

Docusate sodium is not indicated for the treatment of diarrhea. It is specifically used as a stool softener to alleviate constipation by promoting easier passage of stool. This statement indicates a misunderstanding of the intended use of the medication.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse notes that the client's indwelling urinary catheter bag has had no urine output since being emptied 1 hour ago. What should the nurse's first action be?

Correct Answer is B

Explanation

A nurse is providing teaching to a client who takes opioid pain medication and has a new prescription for docusate sodium. Which of the following statements by the client indicates an understanding of the teaching?

Correct Answer is C

Explanation

The client asks the nurse "Why is it necessary to secure the indwelling urinary catheter to my thigh?" The nurse's best response would be. "It is Important to prevent:

When working with clients of any age, the nurse keeps in mind that the key to mutually-satisfying, healthy sexual relationships between partners is most often:

The nurse is prioritizing the day's interventions. Which client should be the first to be taught about the hazards of straining when having a bowel movement? The:

When caring for a patient in pain, the most important principle that the nurse must recognize is that:

Which position would be appropriate for the nurse to perform an abdominal assessment?

The nurse is assessing a 66-year-old client who reports having a fever and feeling weak and dizzy with nausea and vomiting for three days. The nurse observes a dry tongue and oral mucosa, and concentrated urine. To best assess the client's fluid status, which parameter(s) should the nurse check?

The nurse understands that examples of sensible fluid loss in a client are: (SELECT ALL THAT APPLY)