The client says to the nurse, It's my right to refuse ...

[renzo156]

The client says to the nurse, It's my right to refuse medications. Which statement best reflects the nurse's ability to create a mutual understanding?
 
  1. Refusing your medications is your right, but it won't get you out of here.
  2. Can you tell me why you're so angry that you will refuse your medications?
  3. Can you tell me what concerns you have about medications?
  4. If you refuse your medications, you will just get sick again.

Question 2

The psychiatric home health nurse has made repeated attempts to make a home visit to a homebound client, only to find that the client is not at home at the scheduled time. What is the best action by the nurse?
 
  1. Wait outside in the car until the client returns home.
  2. Reevaluate the client's homebound status.
  3. Call the client the day before each scheduled visit as a reminder.
  4. Call the client's landlord and ask to be let into the client's home.

[Anonymous]

Answer to Question 1

3
Rationale: Asking the client to clarify concerns about medications shows that the nurse recognizes the client's goals may be different from the nurse's. Telling the client that refusing medications will result in getting ill or prevent discharge conveys that the nurse is threatened by the client's assertiveness. Interpreting that the client is angry suggests that the nurse is making assumptions about the client's refusal, rather than operating on the facts.

Answer to Question 2

2
Rationale: Clients who are receiving psychiatric services at home must qualify for homebound status for reimbursement purposes. If clients are not at home for scheduled visits, they are no longer homebound and need alternative arrangements for services. Calling the client the day before each scheduled visit as a reminder is appropriate, but the change in homebound status must still be addressed to prevent Medicare fraud. Waiting outside the client's home is impractical and does not address the change in homebound status. The nurse should never enter the client's home without the client's permission. If foul play is suspected or the nurse fears for the client's life, the emergency response team should be called.