You have been providing culturally competent care to a client at a mental health clinic for several years. The client has responded well to the current treatment program
You observe a student nurse greet this client in the clinic waiting room by the client's first name. When the client starts to walk in the wrong direction, you observe the student nurse's attempt to physically guide the client by touch. The client reacts by flailing the arms and pushing the student nurse away. You help the student nurse to identify the most likely areas that produced miscommunication during this interaction as all EXCEPT which of the following? a. proxemics
b. formal style of interaction
c. use of the client's first name
d. ethnocentric behavior of the student nurse
B
The student's behavior is not considered a formal style of interaction. Touching the client and using the client's first name is considered by many to be very informal. In some cultures doing so in a professional environment could be considered extremely rude. The student nurse should be advised on what would be considered a more appropriate style of interaction between the nurse and a client from this culture.
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The nurse is performing a rapid assessment for the assigned clients. Which clients require immediate medical assistance? Select all that apply
1. The client is pale and is breathing in a shallow manner. 2. The client's oxygen saturation level is 74% and is dyspneic. 3. The client is rating his pain at a 3 out of a 10 on a pain scale. 4. The client is unable to follow directions. 5. The nurse determines that the client's level of consciousness is decreasing.
A patient is being treated for an eye infection. Which instructions should the nurse provide the patient about self-care?
Select all that apply. 1. "You should wash your hands before cleansing your eye and putting in eyedrops." 2. "You can soak your lids with warm saline to soften crusts and exudates." 3. "You should not share towels, makeup, or contact lenses with anyone else." 4. "You can apply warm compresses to ease inflammation." 5. "You can rub your eyes with a clean, soft cloth for itching."
A nurse is developing a plan of care for an older adult who is malnourished and on bed rest. Which of the following interventions would be included to prevent skin alterations?
A) turn and reposition every 2 hours B) limit fluids to 500 mL every 24 hours C) do not use lotions or creams on skin D) assess vital signs every 4 hours
These statements are about restraints. Which is correct?
a. Restraints can cause a skin decubitus. b. The agency must report any time a person is in a restraint. c. Restraints affect a person's dignity and self-esteem. d. Restraints decrease confusion and agita-tion.