Nokea
A new graduate nurse completes her first full shift with her preceptor. It was a long, overwhelming day and the new nurse takes a deep breath and says to herself, 'You can do this! Nursing will be a challenge but you are up for it and tomorrow is a new day.' This type of communication is
- A. intrapersonal.
- B. horizontal.
- C. interpersonal.
- D. vertical.
Correct Answer: A
Rationale: Intrapersonal communication is self-talk, as the nurse reflects and motivates herself.
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A patient refuses to take his dose of oral medication. The nurse tells the patient that if he does not take the medication that she will administer it by injection. The nurse's comments can result in a charge of:
- A. Malpractice
- B. Assault
- C. Negligence
- D. Battery
Correct Answer: B
Rationale: Threatening to administer medication by injection against the patient's will constitutes assault, as it involves a threat of unwanted contact.
The infant is admitted to the unit with Tetralogy of Fallot. The nurse would anticipate an order for which medication?
- A. Digoxin
- B. Epinephrine
- C. Aminophyline
- D. Atropine
Correct Answer: A
Rationale: Digoxin is commonly used in Tetralogy of Fallot to improve cardiac function and manage heart failure symptoms.
When administering a capsule that is individually wrapped to a client, when should the wrapping be removed?
- A. When initially obtained from the medicine cart
- B. When placed in the medicine cup
- C. Prior to entering the client's room
- D. At bedside in the client's presence
Correct Answer: D
Rationale: Removing the wrapping at the bedside (D) ensures the client sees the medication, enhancing safety and trust.
The client is admitted to the ER with multiple rib fractures on the right. The nurse's assessment reveals that an area over the right clavicle is puffy and that there is a 'crackling' noise with palpation. The nurse should further assess the client for which of the following problems?
- A. Flail chest
- B. Subcutaneous emphysema
- C. Infiltrated subclavian IV
- D. Pneumothorax
Correct Answer: B
Rationale: The 'puffy' area and 'crackling' noise (crepitus) with palpation are classic signs of subcutaneous emphysema, where air is trapped under the skin, often due to a pneumothorax or rib fractures allowing air to escape into subcutaneous tissue.
The client with a cervical fracture is placed in traction. Which type of traction will be utilized at the time of discharge?
- A. Russell's traction
- B. Buck's traction
- C. Halo traction
- D. Crutchfield tong traction
Correct Answer: C
Rationale: Halo traction is used for cervical fractures and can be maintained post-discharge for stabilization.