NCLEX Review - Management of Care
A 90 year-old is readmitted to the hospital, less than 2 weeks after being
discharged, for the same health concern. What factors contribute to hospital
readmissions among older adults? (Select all that apply.)
1) Reconciliation of medications
2) Poor communication among providers
3) Client health status
4) Family preferences
5) Excellent primary care - ANS - 2, 3, 4
Rationale:
Avoidable hospitalization, especially among older adults living in skilled nursing
facilities, usually results from multiple system failures. The reasons most often
cited include inadequate primary care (including inadequate discharge planning
and lack of reconciliation of medications), poor care coordination, poor skilled
nursing facility quality of care, poor communication among providers and even
family preferences. Not all illnesses can be anticipated and clients with more
complex health issues are readmitted more often, regardless of quality or
coordination of care.
\A Bosnian Muslim woman who does not speak English seeks care at a
community clinic. Through physical gestures, the woman indicates that she has
pain originating in either the pelvic or genital region. Assuming several people
are available to interpret, who would be the most appropriate choice?
1) A female neighbor of the client who is also from Bosnia
2) A female interpreter who does not know the client
3) The client's adult daughter
4) A Bosnian male, who is a certified medical interpreter - ANS - 2
, Rationale:
When the nurse and the client do not speak the same language, or have limited
fluency, the services of an interpreter is needed. But, it may be inappropriate to
have a male interpreter for a female client because the client may not be as
forthcoming. The client may also feel it is inappropriate to have private matters
interpreted by her daughter (especially if they are of a sexual nature or involve
infidelity). To avoid a breach of confidentiality, the nurse should avoid using an
interpreter from the same community as the client. The best response is to have a
female interpreter who does not know the client.
\A client is admitted with a diagnosis of schizophrenia. The client refuses to take
any medication and states, "I don't think I need those medications. They make me
too sleepy and drowsy. I want you to explain their use and side effects of these
medications." The nurse should respond with an understanding of which
statement?
1) A referral is needed to the psychiatrist who should provide the client with
answers to the request
2) Such education is an independent decision of the individual nurse whether or
not to teach clients about their medications
3) Clients with schizophrenia are at a higher risk of psychosocial complications
when they know about their medication's uses and side effects
4) The client has a right to know about the use and side effects of the prescribed
medications - ANS - 4
Rationale:
Clients have a right to informed consent, which includes detailed information
about medications, treatments and diagnostic studies. The other options are
incorrect approaches.
\A client is being prepped for a surgical procedure and the nurse is reviewing the
informed consent with the client. The client asks, "Is there any other way to take
care of this without having surgery?" The nurse has a duty to first:
1) Reassure the client that the surgery is the best treatment option
2) Tell the client if they don't want the surgery, they don't have to have it
A 90 year-old is readmitted to the hospital, less than 2 weeks after being
discharged, for the same health concern. What factors contribute to hospital
readmissions among older adults? (Select all that apply.)
1) Reconciliation of medications
2) Poor communication among providers
3) Client health status
4) Family preferences
5) Excellent primary care - ANS - 2, 3, 4
Rationale:
Avoidable hospitalization, especially among older adults living in skilled nursing
facilities, usually results from multiple system failures. The reasons most often
cited include inadequate primary care (including inadequate discharge planning
and lack of reconciliation of medications), poor care coordination, poor skilled
nursing facility quality of care, poor communication among providers and even
family preferences. Not all illnesses can be anticipated and clients with more
complex health issues are readmitted more often, regardless of quality or
coordination of care.
\A Bosnian Muslim woman who does not speak English seeks care at a
community clinic. Through physical gestures, the woman indicates that she has
pain originating in either the pelvic or genital region. Assuming several people
are available to interpret, who would be the most appropriate choice?
1) A female neighbor of the client who is also from Bosnia
2) A female interpreter who does not know the client
3) The client's adult daughter
4) A Bosnian male, who is a certified medical interpreter - ANS - 2
, Rationale:
When the nurse and the client do not speak the same language, or have limited
fluency, the services of an interpreter is needed. But, it may be inappropriate to
have a male interpreter for a female client because the client may not be as
forthcoming. The client may also feel it is inappropriate to have private matters
interpreted by her daughter (especially if they are of a sexual nature or involve
infidelity). To avoid a breach of confidentiality, the nurse should avoid using an
interpreter from the same community as the client. The best response is to have a
female interpreter who does not know the client.
\A client is admitted with a diagnosis of schizophrenia. The client refuses to take
any medication and states, "I don't think I need those medications. They make me
too sleepy and drowsy. I want you to explain their use and side effects of these
medications." The nurse should respond with an understanding of which
statement?
1) A referral is needed to the psychiatrist who should provide the client with
answers to the request
2) Such education is an independent decision of the individual nurse whether or
not to teach clients about their medications
3) Clients with schizophrenia are at a higher risk of psychosocial complications
when they know about their medication's uses and side effects
4) The client has a right to know about the use and side effects of the prescribed
medications - ANS - 4
Rationale:
Clients have a right to informed consent, which includes detailed information
about medications, treatments and diagnostic studies. The other options are
incorrect approaches.
\A client is being prepped for a surgical procedure and the nurse is reviewing the
informed consent with the client. The client asks, "Is there any other way to take
care of this without having surgery?" The nurse has a duty to first:
1) Reassure the client that the surgery is the best treatment option
2) Tell the client if they don't want the surgery, they don't have to have it
