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A patient describes an unreasonable, irrational fear of snakes. The feeling is so persistent that he can no longer even look at pictures of snakes without feeling uncomfortable. He has tried to identify all the places where he might encounter snakes and avoids them. The nurse recognizes that:
- A. He has a snake phobia.
- B. He is a hypochondriac. Snakes are usually harmless.
- C. He has an obsession. In this case, it is about snakes.
- D. He has a delusion that snakes are harmful. It must stem from an early traumatic incident involving snakes.
Correct Answer: A
Rationale: The correct answer is A: He has a snake phobia. Phobias are irrational and persistent fears of specific objects or situations. In this case, the patient's fear of snakes is unreasonable and causes discomfort even when encountering pictures of snakes. This aligns with the characteristics of a phobia.
Choice B is incorrect as hypochondriasis involves excessive worry about having a serious illness despite medical reassurance. Choice C is incorrect as obsessions are intrusive thoughts that cause anxiety, while the patient's fear of snakes is more of a specific fear rather than an obsession. Choice D is incorrect as delusions are fixed false beliefs, and the patient's fear of snakes is not based on a false belief but rather an irrational fear.
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Which critical thinking skill helps the nurse recognize relationships among data?
- A. Validation.
- B. Clustering-related cues.
- C. Identifying gaps in data.
- D. Distinguishing relevant from irrelevant.
Correct Answer: B
Rationale: The correct answer is B: Clustering-related cues. This critical thinking skill helps the nurse recognize relationships among data by grouping related information together. This aids in identifying patterns, connections, and trends within the data, leading to a better understanding of the situation. Validation (A) involves confirming the accuracy of data, not necessarily recognizing relationships. Identifying gaps in data (C) focuses on missing information rather than relationships among existing data. Distinguishing relevant from irrelevant (D) is important but does not directly address recognizing relationships among data. In summary, clustering-related cues (B) is the most relevant skill for recognizing relationships among data in critical thinking.
A 16-year-old boy has just been admitted for overnight observation after being in an automobile accident. What is the nurse's best approach to communicating with him?
- A. Use periods of silence to communicate respect for him.
- B. Be totally honest with him, even if the information is unpleasant.
- C. Tell him that everything that is discussed will be kept totally confidential.
- D. Use slang language when possible to help him open up.
Correct Answer: B
Rationale: The correct answer is B: Be totally honest with him, even if the information is unpleasant. This is the best approach because honesty builds trust and credibility, crucial in a healthcare setting. It allows the teenager to make informed decisions about his care and fosters a therapeutic relationship.
Explanation for why the other choices are incorrect:
A: Using periods of silence may be misinterpreted as indifference or lack of engagement.
C: Promising total confidentiality may not be feasible in healthcare settings and could lead to potential harm if critical information needs to be shared with others for the patient's safety.
D: Using slang language may come across as unprofessional and may hinder effective communication and understanding between the nurse and the patient.
A nurse is caring for a patient with a history of hypertension. The nurse should educate the patient to monitor for which of the following complications?
- A. Severe headaches and blurred vision.
- B. Weight loss and dizziness.
- C. Increased appetite and tremors.
- D. Nausea and vomiting.
Correct Answer: A
Rationale: The correct answer is A: Severe headaches and blurred vision. Hypertension can lead to complications such as hypertensive crisis, causing symptoms like severe headaches and blurred vision due to increased pressure in the blood vessels. This can indicate a serious health issue requiring immediate medical attention. Weight loss and dizziness (B), increased appetite and tremors (C), and nausea and vomiting (D) are not typically associated with hypertension complications. It's crucial for the nurse to educate the patient on recognizing these signs to prevent further health risks.
Which of the following best describes a proficient nurse?
- A. A nurse who has little experience with a specified population and uses rules to guide performance
- B. A nurse who has an intuitive grasp of a clinical situation and quickly identifies the accurate solution
- C. A nurse who sees actions in the context of daily plans for patients
- D. A nurse who sees a patient's situation as a whole, with long-term goals for the patient, rather than as a list of tasks to be performed
Correct Answer: D
Rationale: The correct answer is D because a proficient nurse should have a holistic view of the patient's situation, focusing on long-term goals rather than just completing tasks. This approach ensures comprehensive care and better outcomes. Choice A is incorrect as it implies reliance on rules over experience. Choice B is incorrect because intuition alone may not always lead to the best solution. Choice C is incorrect as it emphasizes daily plans rather than long-term goals.
A nurse is teaching a patient about managing asthma. Which of the following statements by the patient indicates a need for further education?
- A. I will take my rescue inhaler only during an asthma attack.
- B. I should avoid exposure to allergens that trigger my symptoms.
- C. I will use my inhaler before exercise to prevent symptoms.
- D. I should always carry my inhaler with me.
Correct Answer: A
Rationale: The correct answer is A: I will take my rescue inhaler only during an asthma attack. This statement indicates a need for further education because using a rescue inhaler only during an asthma attack is not the correct way to manage asthma. The purpose of a rescue inhaler is to provide quick relief during an asthma attack, but it should also be used as a preventive measure before exposure to known triggers or before exercise to prevent symptoms. Options B, C, and D all demonstrate good understanding of asthma management by indicating the importance of avoiding triggers, using the inhaler preventively, and carrying the inhaler at all times for emergency situations.