Nokea
A client reports that her family will be moving because her husband is taking a new job in another state. She is very unhappy about the decision and doesn’t want to move. What action should the nurse take next?
- A. Assess the client’s and family’s coping mechanisms in handling stress.
- B. Encourage the client to act excited about the move.
- C. Talk to the husband to get his perspective on the move.
- D. Tell her that all families must cope with new situations from time to time.
Correct Answer: A
Rationale: The nurse should assess how the family usually copes with stressful situations to help them manage the current stressor effectively.
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A nurse is counseling a teenager who smokes one pack of cigarettes a day. The teenager states he likes to smoke with his friends and does not recognize the connection between his smoking and his asthma. When planning an intervention for this person, the nurse must first recognize that the teenager is in the:
- A. Precontemplation stage of change
- B. Preparation stage of change
- C. Action stage of change
- D. Maintenance stage of change
Correct Answer: A
Rationale: In the precontemplation stage, the individual is not yet considering change or recognizing the need to change.
A 63-year-old woman complains of insomnia. Which response is appropriate?
- A. "Do you want a sleeping pill?"
- B. "Make sure that you do not nap during the day even if you are tired."
- C. "Do you feel excessively tired during the day?"
- D. "The nurse practitioner may want to run some simple tests to find out why you are having trouble sleeping."
Correct Answer: C
Rationale: The nurse should assess the quality of sleep and how it affects daily activities before suggesting interventions.
A 27-year-old woman has not received a Pap test in years. This assessment finding identifies an alteration in which functional pattern?
- A. Health-perception–health-management pattern
- B. Elimination pattern
- C. Activity-rest pattern
- D. Self-perception–self-concept pattern
Correct Answer: A
Rationale: Failing to get a Pap test represents an alteration in health perceptions and management.
A nurse is assisting a client in values clarification. Which of the following actions should the nurse assist the client to complete first?
- A. Develop a religious affiliation to assist with the process.
- B. Identify what is meaningful in one’s life.
- C. Act in a way that is consistent with one’s beliefs.
- D. Use beliefs held by others as a guideline for life.
Correct Answer: B
Rationale: Values clarification begins with examining one’s beliefs and then acting in a way that supports those beliefs.
A nurse makes a home visit to a 15-month-old following a hospitalization for a fall. Which finding would be concerning to the nurse?
- A. Radiator heating system in the home
- B. The child drinking from a cup
- C. The child experiencing a temper tantrum
- D. A decorative bowl filled with colorful marbles on the coffee table
Correct Answer: D
Rationale: A bowl of colorful marbles poses a choking hazard, as small objects are a risk for aspiration and foreign body obstruction in toddlers.