A client comes to the nurse's station yelling, "I have to call the FBI. The bombs are set to destroy Washington, D.C. at 1:00 p.m. Please help me. It will be your fault if I don't call
" Which intervention best demonstrates the nurse's sensitivity? 1. Assist the client to become aware that this is a delusional belief.
2. Listen carefully for the underlying emotion expressed by the client's request.
3. Share your concerns that the client's request is unreasonable.
4. Switch the topic of conversation to defuse the client's underlying agitation.
2
Rationale: Listening for the tone underlying the client's request, rather than responding to the actual request, demonstrates the nurse's sincerity and non-defensive approach to the client. Switching topics breaks down communication. Believing the client's request is unreasonable or identifying the belief as delusional invalidates the client's feelings and reflects insensitivity to the client's concern.
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A patient comes to the clinic for his weekly "allergy shot." He missed his appointment the week before because of a family emergency. Which action by the nurse is appropriate in administering his injection?
a. Administer the usual dosage of the allergen. b. Double the dosage to account for the missed injection the previous week. c. Consult with the physician about decreasing the dosage for this injection. d. Reevaluate his sensitivity to the allergen with a skin test.
The nurse is teaching a 5-year-old client about upcoming surgery. Which teaching method is most appropriate for this client?
a. Showing a videotape b. Group discussion c. Play using a doll d. Giving the child a book to read
Which suggestion is appropriate for the pregnant client who is experiencing heartburn?
a. Drink plenty of fluids at bedtime. b. Eat only three meals a day so the stomach is empty between meals. c. Drink coffee or orange juice immediately on arising in the morning. d. Use Tums or Alkamints to obtain relief, as directed by the health care provider.
What statement is descriptive of renal transplantation in children?
a. It is an acceptable means of treatment after age 10 years. b. Children can receive kidneys only from other children. c. It is the preferred means of renal replacement therapy in children. d. The decision for transplantation is difficult because a relatively normal lifestyle is not possible.