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Nurse tells client that she will call surgeon & ask about his request. Surgeon hears nurse's report & prescribes full liquid diet. Nurse used which of following levels of critical thinking?
- A. basic
- B. commitment
- C. complex
- D. integrity
Correct Answer: A
Rationale: The correct answer is A: basic. In this scenario, the nurse is simply relaying information and following a routine procedure by contacting the surgeon for a prescription. This level of critical thinking involves basic understanding and application of knowledge without deeper analysis or evaluation. The other choices are incorrect because: B: commitment involves making decisions and taking responsibility; C: complex involves analyzing and evaluating information; D: integrity involves ethical decision-making. In this case, the nurse's action aligns with basic thinking as she is following a standard protocol without engaging in higher-level critical thinking processes.
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Nurse delegating ambulation of client who had knee arthroplasty 5 days ago to an AP. Which of following info should nurse share with the AP? (Select all that apply.)
- A. The roommate is up independently
- B. Client ambulates with his slippers on over his antiembolic stockings
- C. Client uses front-wheeled walker when ambulating
- D. Client had pain med 30 min ago
- E. Client is allergic to codeine
- F. Client ate 50% of his breakfast this morning
Correct Answer: B, C, D
Rationale: The correct answers are B, C, and D. The nurse should share that the client ambulates with slippers over antiembolic stockings (B) to ensure safety. The nurse should inform that the client uses a front-wheeled walker (C) to maintain stability during ambulation post-knee arthroplasty. Lastly, sharing that the client had pain medication 30 minutes ago (D) is crucial for the AP to monitor for potential side effects and adjust care accordingly.
Incorrect choices:
A: The roommate being up independently is irrelevant to the client's ambulation post-knee arthroplasty.
E: The client's allergy to codeine is important medical information but not essential for the AP to know when delegating ambulation.
F: The client's breakfast intake is not directly related to safe ambulation post-knee arthroplasty.
Nurse talking to parents of school-age child who describe many issues that concern them. Which problem should nurse identify as priority for more assessment & intervention?
- A. He doesn't keep up with other kids in activities like running & jumping
- B. He keeps trying to find ways around household rules; he always wants to make deals with us
- C. We think he is trying too hard to excel in math just to get top grades in his class
- D. He is always afraid the kids at school will laugh at him b/c he likes to sing & write poems
Correct Answer: A
Rationale: The correct answer is A because the child's inability to keep up with other kids in physical activities like running and jumping could indicate underlying physical or developmental issues that require further assessment and intervention. This could be a sign of motor skill delays, muscle weakness, or coordination problems that may impact the child's overall physical health and well-being. Options B, C, and D focus on behavioral, academic, and social issues which are important but not as urgent as addressing potential physical limitations that could affect the child's daily functioning and quality of life.
Nurse educator is teaching module on proper body mechanics during employee orientation. Which statements by new nurse indicates need for more teaching?
- A. My line of gravity should fall outside my base of support
- B. The lower my center of gravity, the more stability I have
- C. To broaden my base of support, I should spread my feet apart
- D. When I lift an object, I should hold it as close to my body as possible
Correct Answer: A
Rationale: Rationale: A nurse's line of gravity should fall within the base of support, not outside, to maintain balance and prevent falls. Choice A is incorrect as it indicates a need for more teaching. Choices B, C, and D are correct statements that promote proper body mechanics. B explains the relationship between center of gravity and stability, C emphasizes broadening the base of support for better balance, and D suggests holding objects close to the body to reduce strain.
Nurse is giving presentation about accident prevention to group of parents & toddlers. Which strategies should nurse include? (Select all that apply.)
- A. Keep toxic agents in locked cabinets
- B. Keep toilet seats up
- C. Turn pot handles toward back of stove
- D. Place safety gates across stairways
- E. Make sure balloons are fully inflated
Correct Answer: A,C,D
Rationale: The correct answers are A, C, and D. A: Keeping toxic agents in locked cabinets prevents toddlers from accessing harmful substances. C: Turning pot handles toward the back of the stove reduces the risk of toddlers pulling them down. D: Placing safety gates across stairways prevents toddlers from falling down stairs. These strategies are crucial for accident prevention.
Incorrect choices: B: Keeping toilet seats up can lead to toddlers falling into the toilet. E: Making sure balloons are fully inflated increases the risk of choking hazards.
Nurse collecting data to evaluate middle adult's psychosocial development. Nurse should expect middle adults to demonstrate which capabilities?
- A. "develop acceptance of diminished strength & increased dependence on others"
- B. feel frustrated that time is too short for trying to start another life
- C. welcome opportunities to be creative & productive
- D. commit to finding friendship & companionship
- E. become involved in community issues & activities
Correct Answer: C, E
Rationale: The correct answers are C and E. Middle adults are typically in the generativity vs. stagnation stage, where they seek to contribute to society and make a positive impact. Choice C, welcoming opportunities to be creative and productive, aligns with generativity. Additionally, becoming involved in community issues and activities (choice E) reflects their desire to engage with society. Choices A and B are incorrect as middle adults do not typically accept diminished strength and do not feel frustrated about time constraints for starting a new life. Choice D is incorrect as seeking friendship and companionship is more characteristic of young adulthood.