Nokea
A nurse begins to bathe a newly admitted client who reports that they have not had anything to eat that day. The nurse interrupts the bath and obtains a healthy meal for the client. This action by the nurse is an example of which of the following?
- A. Countertransference
- B. Boundary crossing
- C. Promoting trust
- D. Veracity
Correct Answer: C
Rationale: Providing a meal addresses the client's immediate need, fostering trust and rapport. This action reflects responsiveness, not countertransference, boundary crossing, or truthfulness.
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A nurse is reinforcing teaching with a client who has a new prescription for valsartan. Which of the following statements by the client indicates an understanding of the teaching?
- A. I should take this medication with a high-potassium meal.
- B. I might need to check my blood pressure regularly.
- C. I need to avoid exercise.
- D. I can stop taking this medication if I feel better.
Correct Answer: B
Rationale: Valsartan requires blood pressure monitoring, showing understanding. Potassium meals, exercise avoidance, and stopping abruptly aren't appropriate.
A nurse is reinforcing teaching with a client who has a new prescription for venlafaxine. Which of the following statements should the nurse include?
- A. You should take this medication with food.
- B. You might experience headaches while taking this medication.
- C. You need to avoid caffeine while taking this medication.
- D. You can expect symptom relief within 24 hours.
Correct Answer: B
Rationale: Venlafaxine can cause headaches, a common side effect. Food enhances absorption, caffeine isn't restricted, and relief takes weeks.
A nurse is reinforcing teaching with a client who has a new prescription for metoprolol. Which of the following statements should the nurse include?
- A. You should take this medication with a high-fiber meal.
- B. You might experience fatigue while taking this medication.
- C. You need to avoid caffeine while taking this medication.
- D. You can stop taking this medication if your blood pressure is normal.
Correct Answer: B
Rationale: Metoprolol can cause fatigue, a common side effect to monitor. Fiber meals, caffeine avoidance, or stopping abruptly aren't recommended.
A nurse is assisting with the care of a client who is at 38 weeks of gestation and in active labor. Which of the following actions should the nurse take?
- A. Apply counterpressure to the client's sacrum during contractions.
- B. Position the client in a supine position during contractions.
- C. Encourage the client to take deep, cleansing breaths between contractions.
- D. Administer oxygen at 2 L/min via nasal cannula during contractions.
Correct Answer: C
Rationale: Deep breaths between contractions promote relaxation and oxygenation. Counterpressure may help some, supine position risks vena cava compression, and oxygen isn't routinely needed.
A nurse is reinforcing teaching with a client who has a new prescription for clopidogrel. Which of the following statements should the nurse include?
- A. Take this medication with food to prevent stomach upset.
- B. You might experience bruising more easily.
- C. You need to avoid eating citrus fruits.
- D. You should take this medication at bedtime.
Correct Answer: B
Rationale: Clopidogrel increases bleeding risk, leading to easy bruising. Food isn't required, citrus isn't restricted, and timing is flexible.