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The Nurse Is Changing an Abdominal Dressing on a Disoriented

Question 14

Multiple Choice

The nurse is changing an abdominal dressing on a disoriented 89-year-old man,when he grabs the nurse's breast with both hands and pulls it toward his mouth,muttering something about "Mary" (his wife) .The best therapeutic response is:


A) Stereotype him as a "dirty old man," and warn the rest of the staff to stay away from him.
B) Get a physician's order for wrist restraints when nurses go near the patient for activities such as dressings, baths, and feedings.
C) Maintain eye contact with the patient and then clearly tell him, and repeat, "I am your nurse, I am coming to help you eat, bathe, and change your stomach bandage. I am not Mary."
D) "That dressing needs changing. Don't be a naughty boy with me again or I will slap your hands and call Mary to come and do all your care herself!"

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