The partner of an older adult client who has Alzheimer's disease reports that he is not eating. The nurse observes that the client's partner refuses to assist the client with feeding. The partner insists that the client feed himself without help. Which of the following is the priority action the nurse should take?
Arrange for Meals on Wheels assistance.
Determine the client's ability to self-feed.
Direct the home health aide to assist with meals.
Refer the client's partner to an Alzheimer's support group.
The Correct Answer is B
Choice A reason: Arranging for Meals on Wheels assistance is not the priority action, as it does not address the underlying issue of the client's partner's refusal to help with feeding. Meals on Wheels may also not be suitable for the client's dietary needs and preferences.
Choice B reason: Determining the client's ability to self-feed is the priority action, as it will help the nurse assess the client's nutritional status and needs, as well as the level of support required from the partner or other caregivers. The nurse can also educate the partner on the importance of adequate nutrition and hydration for the client, and provide strategies to facilitate feeding.
Choice C reason: Directing the home health aide to assist with meals is not the priority action, as it may not be feasible or acceptable to the client or the partner. The home health aide may also not have the skills or training to assist with feeding a client with Alzheimer's disease.
Choice D reason: Referring the client's partner to an Alzheimer's support group is not the priority action, as it does not address the immediate problem of the client's lack of eating. However, it may be a helpful intervention in the long term, as it can provide the partner with emotional support, education, and resources to cope with the challenges of caring for a client with Alzheimer's disease.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason: Touching the hair of an African American client during an assessment does not demonstrate accurate cultural knowledge, as it may be considered disrespectful or intrusive. Hair is a sensitive and personal topic for many African Americans, who may have experienced discrimination or stigma based on their hair texture or style¹. The nurse should ask for permission before touching the client's hair and explain the purpose of the assessment.
Choice B reason: Offering to shake hands when meeting an Asian client of the opposite gender does not demonstrate accurate cultural knowledge, as it may be considered inappropriate or offensive. In some Asian cultures, physical contact between men and women who are not related or married is discouraged or prohibited². The nurse should observe the client's body language and follow the client's lead in greeting gestures.
Choice C reason: Maintaining eye contact when interviewing a Native American client does not demonstrate accurate cultural knowledge, as it may be considered rude or aggressive. In some Native American cultures, eye contact is a sign of disrespect or challenge, especially when talking to elders or authority figures³. The nurse should avoid direct eye contact and use a respectful tone of voice when interviewing the client.
Choice D reason: Including both hot and cold food items on a Hispanic client's menu demonstrates accurate cultural knowledge, as it reflects the concept of balance and harmony in Hispanic culture. Many Hispanics believe that health and illness are influenced by the balance between hot and cold forces in the body and the environment⁴. The nurse should respect the client's food preferences and beliefs and provide a variety of food options.
Correct Answer is D
Explanation
Choice A reason: Reviewing flashcards that identify holding techniques with the group is not an instructional strategy that the nurse should use to promote psychomotor learning. This is a cognitive strategy that can help the participants to recall and recognize the information, but it does not involve the practice or performance of the skills.
Choice B reason: Showing the group a video on breastfeeding techniques is not an instructional strategy that the nurse should use to promote psychomotor learning. This is an affective strategy that can help the participants to observe and appreciate the techniques, but it does not involve the practice or performance of the skills.
Choice C reason: Facilitating a discussion group about the benefits of breastfeeding is not an instructional strategy that the nurse should use to promote psychomotor learning. This is an affective strategy that can help the participants to express and share their opinions and feelings, but it does not involve the practice or performance of the skills.
Choice D reason: Providing dolls for the participants to demonstrate positioning is an instructional strategy that the nurse should use to promote psychomotor learning. This is a psychomotor strategy that can help the participants to apply and practice the skills in a simulated setting, and to receive feedback and guidance from the nurse.
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