During a home visit, the nurse assesses the skin of a client with eczema who reports that an exacerbation of symptoms has occurred during the last week. Which information is most useful in determining the possible cause of the symptoms?
Corticosteroid cream was applied to eczema.
A grandson and his new dog recently visited.
Recently received an influenza immunization.
An old friend with eczema came for a visit.
The Correct Answer is B
A. While the use of corticosteroid cream is relevant to treatment, it does not indicate a new cause for symptom exacerbation.
B. The introduction of a new dog could be a potential allergen, triggering an exacerbation of the client's eczema symptoms.
C. Receiving an influenza immunization is unlikely to be related to eczema exacerbations and is not a common trigger.
D. An old friend with eczema does not present a direct cause for the current exacerbation and is less relevant to the client's current condition.
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Correct Answer is C
Explanation
A. Does not include humor.
Humor can be an appropriate part of the nurse-patient relationship when used sensitively to ease tension or build rapport.
B. Continues after discharge.
The therapeutic relationship typically ends upon discharge, respecting professional boundaries.
C. Focuses on the assessed patient health problems.
The nurse-patient relationship centers on addressing the patient’s identified health issues and providing support, making this option accurate.
D. Focuses on the nurse's ability to build rapport.
While rapport is important, the primary goal is to address the patient’s health needs, not just rapport-building alone.
Correct Answer is A
Explanation
A. The elevated heart rate and respirations suggest the client may be experiencing hypoxia, especially following a thoracotomy. Administering oxygen will help improve oxygen saturation levels and address potential respiratory distress.
B. While pain management is essential, the immediate concern is ensuring adequate oxygenation.
C. Administering IV fluids may be necessary but is secondary to ensuring the client's oxygenation.
D. Encouraging the client to splint and cough is important for preventing complications but does not address the immediate issue of vital signs indicating possible respiratory compromise.