Nokea
After being medicated for anxiety, the client says to the nurse, 'I guess you are too busy to stay with me.' Which response by the nurse is correct?
- A. I'm so sorry, but I need to see other clients.'
- B. I have to go now, but I will come back in 10 minutes.'
- C. You'll be able to rest after the medicine starts working.'
- D. You'll feel better after I've made you more comfortable.'
Correct Answer: B
Rationale: The nurse should respond with empathy and reassurance to address the client's emotional needs. The correct response, 'I have to go now, but I will come back in 10 minutes,' acknowledges the client's feelings while providing a timeframe for the nurse's return, showing care and concern. Choice A, 'I'm so sorry, but I need to see other clients,' prioritizes other tasks over the client's emotional needs, which can increase anxiety. Choice C, 'You'll be able to rest after the medicine starts working,' offers false reassurance and does not address the client's immediate emotional distress. Choice D, 'You'll feel better after I've made you more comfortable,' does not acknowledge the client's concerns and fails to establish a supportive connection with the client.
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On her first visit to the neonatal intensive care unit to see her preterm newborn, the mother's only comment to the nurse is, 'My baby looks so fragile. Do you think my child will make it?' Which is the most appropriate response by the nurse?
- A. "Many infants born as small as yours have done just fine."
- B. "The staff is confident in your child's prognosis because preterm babies do look like this at first."
- C. "It's understandable that your baby looks fragile to you. What have you learned about the condition?"
- D. "Your baby is not as fragile as it appears. Do you find it so frightening that you can't touch your child?"
Correct Answer: C
Rationale: The nurse's response should aim to convey acceptance and encourage the mother to express her concerns. By saying, "It's understandable that your baby looks fragile to you. What have you learned about the condition?", the nurse acknowledges the mother's feelings and prompts her to share her understanding, fostering further communication and addressing any misconceptions. Choices A and B dismiss the mother's concerns by making general statements and do not encourage dialogue. Choice D implies judgment and may deter the mother from opening up about her fears.
A client with untreatable metastasized cancer tells the nurse, 'I think they made a mistake. I don't think I have cancer. I feel too good to be dying.' Which stage of grief is the client experiencing?
- A. Anger
- B. Denial
- C. Bargaining
- D. Acceptance
Correct Answer: B
Rationale: The client is experiencing the stage of denial. This is evident as the client is having difficulty accepting the reality of their diagnosis and denies the presence of cancer despite the evidence. During the anger stage, the individual expresses anger about their situation, questioning why it is happening to them. Bargaining involves attempting to negotiate for more time or a different outcome, acknowledging the reality of death but trying to delay it. Acceptance, on the other hand, is characterized by coming to terms with the inevitability of death and preparing for it peacefully. Therefore, in this scenario, the client's disbelief and refusal to accept the diagnosis align with the denial stage of grief.
Which is an example of an intentional tort?
- A. Negligence
- B. Malpractice
- C. Breach of duty
- D. False imprisonment
Correct Answer: D
Rationale: False imprisonment is a clear example of an intentional tort where one person deliberately confines another without lawful justification. It involves intentional, wrongful restraint of a person's freedom of movement. Negligence, on the other hand, is an unintentional tort that occurs when someone fails to exercise reasonable care, resulting in harm to others. Malpractice, which involves professional negligence, is also classified as an unintentional tort as it is a failure to meet the standard of care expected in a particular profession. Breach of duty, while a legal concept, is not an example of an intentional tort. It refers to a failure to fulfill a legal obligation or duty owed to another party, often leading to legal consequences, but it is not categorized as an intentional tort.
Which response would the nurse provide to a client in labor at 32 weeks' gestation who tells the nurse that she and her husband are very concerned because the baby will be born 2 months early?
- A. You should be concerned. I feel for you.''
- B. If you're concerned, let's talk about it.''
- C. Try not to worry about it; just concentrate on your labor.''
- D. Don't worry; the care of preterm babies has greatly improved.''
Correct Answer: B
Rationale: The correct answer is B: ''If you're concerned, let's talk about it.'' Offering to talk with the client encourages her to verbalize concerns, serving as an outlet for tension. The nurse's first step should be to listen to the client's concerns and emotions before providing more specific information. Choice A is incorrect as telling the client she should be concerned reinforces fears and conveys sympathy rather than empathy. Choice C is incorrect because telling the client not to worry and just concentrate on labor denies the client's feelings and cuts off communication. Choice D is incorrect as telling the client not to worry because care has improved denies the client's feelings and provides false reassurance.
A client injured in a motor vehicle accident was brought to the emergency department and taken immediately for a scan. The client's family arrives and asks about the client's condition. Which response would the nurse provide?
- A. Please do not worry; everything will be all right.
- B. I am sorry; I do not have any information about the client.
- C. You will have to wait for the primary health care provider.
- D. Please wait; I will update you as soon as I have any information.
Correct Answer: D
Rationale: In this situation, the most appropriate response for the nurse to provide to the client's family is to assure them that they will be updated as soon as there is relevant information available. This response not only acknowledges the family's concern but also demonstrates the nurse's commitment to keeping them informed. Option A, providing false reassurances, is not advisable as it may impact the family's ability to cope with potential bad news. Option B, stating that the nurse has no information, is not helpful and can cause distress. Option C, directing the family to the primary health care provider, is not ideal as the nurse should strive to communicate directly with the family to establish trust and provide support.