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An adolescent patient has just been found to have broken one of the unit rules. The nurse imposes the consequence of losing phone privileges. In this instance, the nurse is acting as
- A. advocate.
- B. caregiver.
- C. teacher.
- D. parent surrogate.
Correct Answer: D
Rationale: The nurse assumes a parental role when setting limits, such as imposing consequences for rule-breaking.
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Which role of the nurse is most likely to create difficulty for the nurse/client relationship if the client confuses physical care with intimacy and sexual interest?
- A. Teacher
- B. Caregiver
- C. Advocate
- D. Parent surrogate
Correct Answer: B
Rationale: Physical care in the caregiver role can be confused with intimacy, potentially eroding the therapeutic relationship.
The nurse has been working with a patient with an eating disorder for one week. During the morning treatment team meeting, the treatment plan is updated. Which of the following would be appropriate interventions at this time in the nurse/patient relationship? Select all that apply.
- A. Exploring perceptions of reality
- B. Promoting a positive self-concept
- C. Explaining the boundaries of the relationship
- D. Working through resistance
- E. Assisting in identifying problems
Correct Answer: A,B,D
Rationale: Tasks of the working phase include exploring perceptions of reality, promoting a positive self-concept, and working through resistance.
A patient being discharged appears angry with the nurse when the nurse attempts to review discharge instructions with the patient. The nurse can best assist the patient in this stage of the relationship with which of the following responses?
- A. We have to go over these instructions before you can go. Please try to listen
- B. Would you rather not be discharged today?
- C. I can sense you are angry this morning. Tell me how you feel about being discharged today.
- D. You should be able to regulate your feelings better by now. Why are you angry?
Correct Answer: C
Rationale: Acknowledging the client's angry feelings and assuring the client that this response is normal helps address the sense of loss during termination.
The nurse assesses fine hand tremors in a patient with a history of heavy alcohol use. If the nurse understands that the tremors are a direct result of alcohol use, the nurse is using which pattern of knowing, according to Carper?
- A. Aesthetic knowing
- B. Ethical knowing
- C. Personal knowing
- D. Empirical knowing
Correct Answer: D
Rationale: Empirical knowing is obtained from the science of nursing, such as understanding clinical symptoms related to alcohol use.
A client who had been in a substance abuse treatment program asks the nurse to attend a picnic with his family after the client is discharged. The nurse should explain the importance of which of the following?
- A. Maintaining professional boundaries
- B. Attending family events to support recovery
- C. Ensuring family involvement in treatment
- D. Encouraging social interactions post-discharge
Correct Answer: A
Rationale: A therapeutic relationship is professional, focused on meeting the client's needs, and is terminated when the client no longer needs services. The nurse must maintain professional boundaries.