Level: Clinical
Difficulty: Medium
Subtopic: Clinical practice guidelines
NCLEX: The quality-improvement nurse reviewing fall-rate data is being evaluated for evidence-based practice and clinica…
Statistics or evidence-based practice Management of Care
Case Study
The quality-improvement nurse reviewing fall-rate data is being evaluated for evidence-based practice and clinical practice guidelines. Assessment data include fall rates increased from 2.1 to 4.8 per 1,000 patient days after a process change. Which nurse response best supports psychosocial integrity?
Question
A. False reassurance that nothing is wrong.
B. Changing the subject when the client expresses fear.
C. Therapeutic presence, active listening, validation, and suicide or violence screening when indicated.
D. Promising outcomes that cannot be guaranteed.
B. Changing the subject when the client expresses fear.
C. Therapeutic presence, active listening, validation, and suicide or violence screening when indicated.
D. Promising outcomes that cannot be guaranteed.
Rationale
Correct answer: C. Therapeutic presence, active listening, validation, and suicide or violence screening when indicated.
Rationale: Psychosocial integrity items reward therapeutic communication and appropriate safety screening, not avoidance or false promises.
Hint: Apply ABCs, client stability, and NCSBN clinical judgment steps before choosing an intervention.
Rationale: Psychosocial integrity items reward therapeutic communication and appropriate safety screening, not avoidance or false promises.
Hint: Apply ABCs, client stability, and NCSBN clinical judgment steps before choosing an intervention.