Exhibits

A nurse is assessing a client who has schizophrenia. Which of the following findings should the nurse report to the provider? (Click on the “Exhibit” button for additional information about the client. There are three tabs that contain separate categories of data.)

Hallucinations

Temperature

Weight gain

Blood pressure

Answer and Explanation

The Correct Answer is B

Choice A Reason: Hallucinations are a common symptom of schizophrenia and may not require immediate reporting to a provider unless they represent a change from the patient’s baseline or are causing distress.
Choice B Reason: The client’s temperature of 39.4° C (103° F) is significantly higher than the normal body temperature range of 36.5° C to 37.5° C (97.7° F to 99.5° F). This indicates a fever, which could suggest an infection or another acute health issue that requires immediate attention.
Choice C Reason: While weight gain is a concern for patients with schizophrenia, especially due to the potential side effects of medications like olanzapine, it is not typically an acute issue requiring immediate reporting unless it is rapid and significant, which could indicate other health problems.
Choice D Reason: The client’s blood pressure reading of 128/82 mm Hg falls within the normal range for adults, which is less than 120/80 mm Hg for normal blood pressure. Therefore, it does not need to be reported urgently.

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Correct Answer is A

Explanation

Choice A reason: Autonomy is the principle that addresses the patient's right to make their own decisions regarding their health care, based on their own values and preferences. When the nurse supports the client's refusal of medications, they are respecting the client's autonomy. This principle is fundamental in healthcare ethics, emphasizing the belief that patients are capable of making informed decisions about their own treatment.

Choice B reason: Beneficence involves actions that promote the well-being of others. In the context of healthcare, this principle often refers to the healthcare provider's duty to act in the patient's best interest. While beneficence is important, it must be balanced with autonomy, especially when the patient's wishes are known and legally sound.

Choice C reason: Veracity refers to the obligation to tell the truth and not deceive others. In the healthcare setting, this means providing accurate information to patients about their condition and treatment options. While veracity is crucial, it does not directly relate to the support of a patient's decision to refuse treatment.

Choice D reason: Justice in healthcare is about fairness in the distribution of resources and respect for people's rights. It involves ensuring that all individuals have equal access to treatment and care. The principle of justice does not specifically address the issue of supporting a patient's decision to refuse treatment.

A. A unit secretary who speaks the same language as the client. B. Another client who speaks the same language as the client. C. A translator of the same gender as the client. D. A family member of the client.

Correct Answer is C

Explanation

Choice A reason: While a unit secretary who speaks the same language could potentially communicate with the client, they may not be trained in medical terminology or confidentiality practices. Effective communication in healthcare settings requires more than just language proficiency; it involves understanding the nuances of medical dialogue and ensuring privacy and accuracy.

Choice B reason: Relying on another client for translation is not advisable. This could breach confidentiality, and the other client may not have the necessary skills to translate medical information accurately. Additionally, it places an undue burden on the client, who is there to receive support, not to provide services.

Choice C reason: A professional translator, preferably of the same gender as the client if it makes the client more comfortable, is the best option. Professional translators are trained to handle medical terminology and to navigate the cultural nuances that may arise in communication. They are also bound by confidentiality agreements to protect the client's privacy³.

Choice D reason: While a family member may be able to communicate effectively in the client's language, there are potential issues with privacy, accuracy, and dynamics that could affect the client's comfort and willingness to share openly in a support group setting. Family members may also unintentionally alter or withhold information based on their own biases or desires.

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Exhibits A nurse is assessing a client who has schizophrenia. Which of the following findings should the nurse report to the provider? (Click on the “Exhibit” button for additional information about the client. There are three tabs that contain separate categories of data.)

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Correct Answer is A

Explanation

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Correct Answer is C

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Exhibits A nurse is assessing a client who has schizophrenia. Which of the following findings should the nurse report to the provider? (Click on the “Exhibit” button for additional information about the client. There are three tabs that contain separate categories of data.)

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Exhibits

A nurse is assessing a client who has schizophrenia. Which of the following findings should the nurse report to the provider? (Click on the “Exhibit” button for additional information about the client. There are three tabs that contain separate categories of data.)