An 80-year-old client is living alone after his spouse of more than 50 years died recently. While visiting the client at home, the nurse finds that the client is eating well and maintaining his mobility but neglecting his personal hygiene. The nurse notes that the client's clothes are soiled and his body odor is strong. Which action would the nurse do first?
Investigate the reasons why the client is not bathing or doing laundry
Offer time-saving bathing tips and advice on easy methods for washing clothes
Incorporate the help of the client's family to assist with bathing
Explain to the client about the health benefits of keeping clean
The Correct Answer is A
A. Investigate the reasons why the client is not bathing or doing laundry:
Before providing any interventions or suggestions, the nurse should first understand the underlying reasons for the client's neglect of personal hygiene. There could be various factors contributing to this behavior, such as physical limitations, cognitive decline, depression, grief from the recent loss of a spouse, lack of motivation, or environmental barriers. By investigating the root causes, the nurse can tailor interventions and support strategies to address the specific needs and challenges of the client.
B. Offer time-saving bathing tips and advice on easy methods for washing clothes:
While providing tips and advice may be helpful, it's essential to first understand why the client is neglecting personal hygiene to ensure that the suggestions are appropriate and feasible. Without addressing the underlying reasons, offering advice alone may not effectively address the issue.
C. Incorporate the help of the client's family to assist with bathing:
Involving the client's family can be a valuable support strategy, but it should come after understanding the client's individual circumstances and preferences. Additionally, not all clients may have readily available family members to assist with personal care tasks.
D. Explain to the client about the health benefits of keeping clean:
While education about the importance of personal hygiene is essential, it may not be the most immediate or effective intervention if there are underlying barriers preventing the client from maintaining cleanliness. Understanding the client's specific situation should precede any educational efforts to ensure relevance and effectiveness.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. A 79-year-old woman who has dysphagia following her recent stroke:
Dysphagia, or difficulty swallowing, following a stroke is a serious condition that requires careful management to prevent complications such as aspiration pneumonia or malnutrition. While dysphagia presents challenges, it may not necessarily indicate a deficit in knowledge, experience, or skills on the part of the client. Dysphagia management typically involves interventions by healthcare professionals rather than self-management by the client.
B. An 80-year-old man, newly diagnosed with diabetes, who shows an inability to manipulate glucometer and test strips:
This scenario suggests a deficit in knowledge and skills related to managing diabetes, a chronic condition that requires ongoing monitoring of blood glucose levels. Proper use of a glucometer and test strips is essential for self-management of diabetes. The client's inability to manipulate these devices indicates a potential gap in understanding or ability to perform necessary self-care tasks, which could compromise his health if left unaddressed.
C. An 89-year-old man who has recently lost the ability to climb stairs due to an exacerbation of his heart failure:
Losing the ability to climb stairs due to heart failure exacerbation is a significant functional decline rather than a deficit in knowledge, experience, or skills. While it may impact the client's mobility and quality of life, it doesn't necessarily indicate a lack of understanding or skills that could compromise health. The focus for this client would be on managing the exacerbation of heart failure and potentially regaining functional abilities through rehabilitation or other interventions.
D. A 78-year-old woman who states that she lost all hope since her spouse's death 5 months prior and no longer wants to stay active:
This scenario suggests emotional distress and loss of motivation following the death of the client's spouse rather than a deficit in knowledge, experience, or skills related to health management. While emotional well-being is important for overall health, addressing this issue would involve psychosocial support and interventions rather than focusing solely on deficits in knowledge or skills.
Correct Answer is C
Explanation
A. Standards provided by nursing associations:
Nursing associations establish standards of practice to guide nurses in delivering safe and effective care. These standards outline the expectations and responsibilities of nurses in various healthcare settings. While adhering to nursing standards is important, they may not always encompass the full spectrum of clinical complexities faced by older adult populations. Nursing standards often provide general guidelines rather than specific evidence-based recommendations for complex clinical scenarios.
B. Scientific data about theories, life adjustments, and pathophysiology of aging:
Scientific data related to theories, life adjustments, and pathophysiology of aging are essential for understanding the physiological, psychological, and social aspects of aging. This knowledge helps nurses comprehend the unique healthcare needs of older adults and informs their clinical decision-making. While scientific data provides a foundational understanding of aging processes, it may not always translate directly into evidence-based practice guidelines for managing specific health conditions or complex clinical situations.
C. Evidence-based practice:
Evidence-based practice (EBP) involves integrating the best available evidence from scientific research with clinical expertise and patient preferences to inform decision-making in patient care. EBP ensures that nursing interventions are grounded in research findings and tailored to individual patient needs and preferences. By critically appraising and applying research evidence to clinical practice, nurses can provide high-quality, patient-centered care that is supported by the latest scientific knowledge.
D. A large pool of knowledgeable colleagues in advanced practice roles:
Colleagues in advanced practice roles, such as nurse practitioners or clinical nurse specialists, can serve as valuable resources for sharing expertise and knowledge in caring for older adult populations. These colleagues may offer insights, guidance, and recommendations based on their advanced clinical training and experience. While collaborating with knowledgeable colleagues is important for professional development and sharing best practices, it should complement, rather than replace, evidence-based practice as the foundation for providing high-quality care.
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