Two nurses are in the day room when a visitor approaches and starts yelling about the care his mother is receiving. One nurse says, "I'm sorry you are upset. What can I do for you?" The visitor continues to complain more loudly
What should the other nurse do? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Quietly direct other people out of the room.
2. Leave the room and call security.
3. Say, "Who are you?"
4. Move toward the visitor and say, "Keep your voice down."
5. Stay next to the other nurse.
1,2
Rationale 1: Isolating a person who is angry and aggressive helps by taking away part of the audience. This is also a strategy to protect others.
Rationale 2: It may be that the visitor is just upset and will calm down quickly with the other nurse's verbal intervention, but that is not assured.
Rationale 3: This question may further infuriate the visitor because the nurses don't know him or his mother. Also, one nurse should carry the conversation.
Rationale 4: The nurse should not make a move toward the visitor or demean him.
Rationale 5: The nurse should move away and out of the room to call security.
Global Rationale:
You might also like to view...
A nurse is conducting a medication review with a client recently diagnosed with gout. Which statement by the client about medication use would the nurse interpret as possibly related to this diagnosis?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "I take niacin to help control my cholesterol." 2. "The only medication that helps control my tremor is levodopa." 3. "I have taken tramadol for back pain for the last 6 months." 4. "I haven't had a cold since I started taking vitamin C every day." 5. "My cardiologist told me to take a low-dose aspirin every day, but I take two full-strength because my dad had heart trouble."
The nurse is preparing to administer an intravenous infusion containing regular insulin for a patient diagnosed with diabetic ketoacidosis. Which nursing intervention added to the patient's plan of care has the highest priority?
1. Check urine for ketone bodies every shift. 2. Check blood glucose levels every 2 hours. 3. Monitor serum calcium levels closely. 4. Adjust infusion rate according to glucose readings.
The family of a spinal cord–injured patient who is in the rehabilitation phase wants to take the patient outdoors for a visit. Because it is 90º outside and very humid, the nurse will sug-gest:
1. not going outside at all, but remaining in the hospital. 2. taking a spray bottle to spray water on the patient to cool by evaporation. 3. taking a light sweater for insulation of the patient. 4. that the patient drink at least 32 ounces of water during the outing.
An adolescent recovering from a spinal cord injury calls out for help. The patient's face is bright red, and the patient is experiencing a severe headache. What is the first thing that the nurse should do for this patient?
A) Administer mouth-to-mouth resuscitation. B) Assess if the urinary retention catheter is blocked. C) Massage the lower extremities to cause vasodilation. D) Lower the head of the bed to increase cerebral circulation.