The RN learns that the father of a teenage client was killed in a car accident when he was a baby, and his mother has raised him on her own.
How should the nurse interpret this family’s functionality?
The teenager is probably difficult for a single mother to manage, so the family will be referred to social services.
Further assessment needs to be done to determine if the family needs assistance.
The mother needs assistance to cope with the stress of raising a teenager on her own.
The mother will need financial support while she takes off work to care for her son.
The Correct Answer is B
This is because the nurse should not make assumptions about the family’s functionality based on their history or situation, but rather gather more information to identify their strengths and needs.
Choice A is wrong because it implies that the teenager is a problem and the mother is incapable of managing him, which is disrespectful and judgmental.
Choice C is wrong because it assumes that the mother is stressed and needs coping skills, which may not be true.
Choice D is wrong because it suggests that the mother is financially dependent on her son, which is not relevant to the question.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
The SBAR is used to organize and standardize communication between members of the health care team about a patient’s condition. It is an acronym for Situation, Background, Assessment, and Recommendation.
Choice B is wrong because the SBAR is not used to help Physical Therapy determine the client’s abilities.
Physical Therapy may use other tools or methods to assess the client’s functional status.
Choice C is wrong because the SBAR is not used to help physicians with diagnoses.
The SBAR is a communication tool, not a diagnostic tool.
Physicians may use other sources of information or tests to make diagnoses.
Choice D is wrong because the SBAR is not used to educate clients about their disease processes.
The SBAR is a tool for interprofessional communication, not for patient education.
Clients may receive education from other sources or materials.
Correct Answer is ["A","B","C"]
Explanation
These actions ensure the safety of the client by reducing the risk of falls, confusion and injury.
Keeping a call bell within the client’s reach allows them to ask for help when needed.
Keeping a dim light on at night helps them orient themselves and see their surroundings.
Keeping unnecessary furniture out of the way prevents tripping and cluttering. Choice D is wrong because keeping all side rails up at all times can be considered a form of physical restraint, which is associated with many professional, legal and ethical challenges. Physical restraint should only be used as a last resort when other alternatives have failed or are not feasible. Keeping all side rails up can also increase the risk of injury if the client tries to climb over them.
Choice E is wrong because keeping all lights off at night can increase the risk of falls and confusion for the client.
Older adults may have impaired vision and cognition, and they may need to use the bathroom frequently at night. Keeping all lights off can make it difficult for them to find their way and increase their anxiety.
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