An appropriate question when assessing a client's self-expectations about weight loss is:
- A. What makes you think you can change your eating habits?
- B. How do you feel about losing weight?
- C. How important is it that you lose weight?
- D. What do you think is a realistic weekly weight loss for you?
Correct Answer: D
Rationale: Nurses should assist clients to evaluate themselves and make behavior changes. Listening to clients, supporting clients' strengths, assisting clients to look at themselves in totality, and encouraging clients to set attainable goals should be part of the nurse-client relationship.
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The nurse is caring for a dying client who has persistently requested that the nurse 'help her to die and be in peace.' According to the Code of Ethics for Nurses, the nurse should:
- A. Ask the client whether she has signed the advance directives document.
- B. Tell the client that he or she will ask another nurse to care for her.
- C. Instruct the client that only a physician can legally assist a suicide.
- D. Try to make the client as comfortable as possible, but refuse to assist in death.
Correct Answer: D
Rationale: Try to make the client as comfortable as possible but refuse to assist in death. One of the competencies necessary for nurses to have in giving high quality care to clients/families during the end of life care is: apply legal and ethical principles in the analysis of complex issues and end-of-life care, recognizing the influence of personal values, profession codes, and client preferences.
What is the reason for a contract between nurse and client?
- A. Contracts state the roles the participants take.
- B. Contracts are indicative of the feeling tone established between participants.
- C. Contracts are binding and prevent either party from ending the relationship prematurely.
- D. Contracts spell out the participation and responsibilities of both parties.
Correct Answer: D
Rationale: A contract emphasizes that the nurse works with the client, rather than doing something for the client. Working with suggests that each party is expected to participate and share responsibility for outcomes. Contracts do not, however, stipulate roles or feeling tone, nor is premature termination expressly forbidden.
A nurse is reviewing a patient's medical record. The record indicates the patient has limited shoulder flexion on the left. Which plane of movement is limited?
- A. Horizontal
- B. Sagittal
- C. Frontal
- D. Vertical
Correct Answer: B
Rationale: Sagittal motion occurs in the midline plane of the body.
A couple from the Philippines living in the United States is expecting their first child. In providing culturally competent care, the nurse must first:
- A. review their own cultural beliefs and biases
- B. respectfully request that the couple utilize only medically approved health care providers
- C. realize that the clients have to learn their new country's accepted medical practices
- D. study family dynamics to understand the male and female gender roles in the clients' culture
Correct Answer: A
Rationale: The nurse must first examine their own cultural biases to avoid imposing personal beliefs, ensuring culturally sensitive care. The other options assume or impose external standards without prioritizing self-awareness.
When planning care of a client who has a been diagnosed with Amphetamine Abuse, the nurse should use the knowledge that:
- A. amphetamines increase energy by increasing dopamine levels at neural synapses.
- B. amphetamines have a low risk of tolerance or addiction.
- C. amphetamines produce a 10-20-second rush followed by a 2-4-hour high.
- D. addiction to barbiturates and amphetamines is rare because they have opposite effects.
Correct Answer: A
Rationale: Amphetamines cause the release of norepinephrine and dopamine from storage vesicles into the synapse, increasing stimulation. Tolerance and withdrawal patterns are well-documented, and prolonged use can lead to psychosis.