The patient is being readmitted to an inner city hospital for ...

[Capo]

The patient is being readmitted to an inner city hospital for chest pain after being discharged 3 months earlier after having a heart attack. The patient was referred to the hospital's cardiac rehabilitation program after her previous admission.
 
  The patient states that she began going to cardiac rehabilitation and liked it but stopped. When asked why, she states that, at the beginning, the classes were at 9 AM, but then got switched to 7 PM, when it's dark. The cardiac rehabilitation program was within walking distance of the patient's home. What is the most likely cause of the patient's unwillingness to go to cardiac rehabilitation?
  a. Lack of transportation
  b. Fear of walking at night
  c. Reimbursement issues
  d. Noncompliance

Question 2

The nurse is working in a community clinic when a man and woman bring a 12 year-old boy in, stating that the child fell down a flight of stairs and hurt his arm. The nurse notices several other bruises on the child's body at varying stages of healing.
 
  The boy is placed on the stretcher. When asked how he hurt himself, he states that he does not remember. However, the nurse notices that the boy continuously avoids looking at the man, while the man stares at him constantly. The nurse should
  a. Ask the boy if the man hurt him.
  b. Confront the man directly.
  c. Ask the man and woman to step out.
  d. Ask the woman if the man hurt the boy.

[okolip]

Answer to Question 1

ANS: B
A community assessment should be done to determine the level of community violence at night in the patient's neighborhood. She claimed that she liked the program when it was at 9 AM. She did not mention finances as a reason for not going, and the program was within walking distance to her house. Noncompliance is a label given unfairly to patients. Most noncompliance is caused. The cause should be identified and dealt with, so the therapy will be successful.

Answer to Question 2

ANS: C
Ask the man and woman to step out. When dealing with patients at risk for or who have suffered abuse, it is important to provide protection and to interview the patient at a time when he or she has privacy, and the individual suspected of being the abuser is not present. The boy may be less likely to be forthcoming with his attacker in the room. Confronting the man directly may lead to violence. The woman may also be a victim of abuse and may fear retribution if she discusses their problems with health care providers.

[Capo]

TYSM

[rachel]

Excellent