The patient draws back when the nurse reaches over the side rails ...

[ec501234]

The patient draws back when the nurse reaches over the side rails to take his blood pressure. What should the nurse do first to promote effective communication?
 
  a. Tell the patient that the blood pressure can be taken at a later time.
  b. Rotate the nurses who are assigned to take the patient's blood pressure.
  c. Continue to perform the procedure quickly and quietly.
  d. Apologize for startling the patient and explain the need for contact.

Question 2

How should the nurse promote comfort for the terminally ill client, specific to nausea and vomiting?
 
  a. Provide frequent mouth care.
  b. Suction oral secretions.
  c. Increase the fluid intake.
  d. Offer a high-residue diet.

[izzat]

Answer to Question 1

D

Feedback
A Telling the patient that the blood pressure can be taken at a later time does not promote effective communication.
B Rotating the nurses who are assigned to take the patient's blood pressure impedes the nurse's ability to form a therapeutic, helping relationship.
C Continuing to perform the procedure quickly and quietly may send a negative nonverbal message to the patient. It also does not promote effective communication.
D Nurses often have to enter a patient's personal space to provide care. The nurse should convey confidence, gentleness, and respect for privacy. Apologizing for startling the patient and explaining the need for contact demonstrates respect and provides information so the patient can understand the need for personal contact.

Answer to Question 2

A
To promote comfort for the terminally ill client, specific to nausea and vomiting, the nurse should administer anti-emetics, provide oral care at least every two to four hours, offer a clear liquid diet and ice chips, and avoid liquids that increase stomach acidity such as coffee, milk, and citrus acid juices.
Suctioning would remove respiratory secretions.
Increasing the fluid intake may help prevent constipation.
A low-residue diet may help prevent diarrhea.