After a month, Mr. Gary's wife started going to her old routine, She said 'Gary would want me to continue living my life' This is an example of what stage of grieving?
- A. Denial
- B. Anger
- C. Bargaining
- D. Acceptance
Correct Answer: D
Rationale: Resuming routine with 'Gary would want is acceptance (D), per Kubler-Ross peace with loss, moving forward. Denial (A), anger (B), and bargaining (C) resist or alter reality. Acceptance reflects her adjustment, making it correct.
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Which of the following nursing intervention is appropriate to prevent pulmonary embolus in a patient who is prescribed bed rest?
- A. Limit the client's fluid intake
- B. Encourage deep breathing and coughing
- C. Use the knee gatch when the client is in bed
- D. Teach the patient to move legs in bed
Correct Answer: D
Rationale: Bed rest risks venous stasis, a pulmonary embolus cause. Leg movement promotes circulation, preventing clots from forming and traveling to lungs. Fluid limits dehydration but not emboli directly, deep breathing aids lungs but not veins, and knee gatch increases stasis. Nurses teach exercises, reducing thromboembolism risk, enhancing recovery safety.
A client with a tracheostomy gets easily frustrated when trying to communicate personal needs to the nurse. The nurse determines that which method for communication may be the easiest for the client?
- A. Use a pad and paper.
- B. Use a picture or word board.
- C. Have the family interpret needs.
- D. Devise a system of hand signals.
Correct Answer: B
Rationale: For a tracheostomy client, a picture or word board (B) is easiest, allowing quick, clear communication without speech. Paper (A) requires literacy and dexterity. Family interpretation (C) is unreliable. Hand signals (D) need setup. B is correct. Rationale: Visual aids bypass vocal limitations, enhancing autonomy, a practical solution per speech therapy standards.
Which of the following statement best describe battery?
- A. Failure to meet the standard of care
- B. An intentional threat
- C. Touching the client without consent
- D. Causes emotional harm
Correct Answer: C
Rationale: Battery is touching without consent (C), per law e.g., unpermitted procedure. Standards (A) is malpractice, threat (B) assault, emotional harm (D) not key. C best defines battery's physical breach, making it correct.
The nurse reported Mr. Gary's fall to improve safety. This is an example of?
- A. Incident reporting
- B. Documentation
- C. Health promotion
- D. Care transition
Correct Answer: A
Rationale: Reporting a fall is incident reporting (A) adverse event log, per definition. Documentation (B) records, promotion (C) well-being, transition (D) moves not report-specific. A fits the nurse's action for Mr. Gary's safety, making it correct.
A client who recently underwent a coronary artery bypass graft is taking furosemide and metoprolol following the procedure. While developing a plan for a heart-healthy diet with the nurse, the client states that diet did not contribute to the heart disease and that the client should be fine just continuing to take the medications. According to the Stages of Change Model, which stage of change is the client in related to diet?
- A. Precontemplation
- B. Contemplation
- C. Preparation
- D. Maintenance
Correct Answer: A
Rationale: The Stages of Change Model tracks behavior shift, and this client's denial of diet's role in heart disease places them in precontemplation. Here, individuals show no intent to change within six months, often resisting evidence like diet's link to atherosclerosis clinging to beliefs that meds alone suffice. Contemplation involves considering change, preparation plans it, and maintenance sustains it none apply, as the client isn't pondering dietary shifts. This stage reflects unawareness or defiance, common post-surgery when focusing on recovery, not prevention. Nursing must gently challenge this, using education like explaining sodium's impact on heart strain to nudge awareness, critical for moving them toward contemplation and eventual heart-healthy habits, preventing further cardiac issues.
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