Nokea
An elderly patient must be physically restrained. Who is responsible for the patient's safety?
- A. Unlicensed assistive personnel who apply the restraint
- B. Family member who agrees to the application of the restraint
- C. The nurse assigned to care for the patient.
- D. Health care provider who prescribed the application of restraint
Correct Answer: C
Rationale: The nurse is responsible for the patient’s safety, including the appropriate use of restraints and ensuring the patient is monitored appropriately. The nurse is accountable for assessing the need for restraints, their proper application, and ongoing evaluation of the patient’s condition while restrained
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Which assessment finding should be considered a high risk factor for adolescent suicide?
- A. Being sexually abused.
- B. Having experienced panic attacks
- C. Being mildly cognitively impaired
- D. Having a diagnosis of type 1 diabetes
Correct Answer: A
Rationale: Adolescents who have been sexually abused are at a higher risk for suicide. Trauma can significantly impact mental health, increasing the risk of depression, self-harm, and suicidal thoughts.
A patient is experiencing distress with midlife transition. Which statement provides support that the patient is successfully managing this stressor?
- A. “I won’t give up on my dream to be rich.”
- B. “I wasn’t being realistic when I set being rich as my life’s goal.”
- C. “I’ll never be rich, but I can save enough to live comfortably.”
- D. “Being rich doesn’t necessarily make a person happy.”
Correct Answer: C
Rationale: Successfully managing midlife transitions involves finding realistic and satisfying alternatives to earlier, unmet goals, demonstrating emotional growth and adaptability.
Which activity therapy should the nurse recommend to the treatment team to assist the patient to relieve tension and achieve increased body awareness?
- A. Music therapy
- B. Dance therapy
- C. Recreation
- D. Relaxation exercises
Correct Answer: B
Rationale: Dance therapy is a form of activity therapy that uses movement and dance to promote emotional, social, cognitive, and physical integration and well-being. It can help individuals relieve tension, connect with their bodies, and increase body awareness. Through dancing, patients can release emotions, express themselves non-verbally, and improve their overall sense of well-being. Additionally, dance therapy can also help improve muscle tone, coordination, and flexibility, thereby contributing to physical health. Overall, dance therapy can be a beneficial intervention to assist the patient in relieving tension and achieving increased body awareness.
A nurse, leading an inpatient group dealing with women’s issues, identifies a patient who is assuming the role of aggressor. Which behavior characterizes this role?
- A. Mediating conflicts and disagreements
- B. Criticizing the contributions of others
- C. Seeking a position between contending sides
- D. Remaining quiet and refraining from participating in group discussions
Correct Answer: B
Rationale: In a group setting, a patient assuming the role of aggressor typically exhibits behaviors such as criticizing the contributions of others, being hostile, confrontational, and attempting to assert dominance. This behavior can create a negative and hostile environment in the group, undermining the therapeutic process. It is important for the nurse to recognize and address this behavior in order to promote a safe and supportive atmosphere for all group members to participate and benefit from the sessions.
Which intervention will the nurse planning care for a patient with acute grief implement?
- A. Encouraging dependence on the nurse for support
- B. Providing information about the grief process
- C. Suggesting utilization of community resources in a few weeks
- D. Advising the patient to minimize contact with nonfamily members
Correct Answer: B
Rationale: Providing information about grief is an important intervention for individuals experiencing acute grief. It helps the patient understand their emotional reactions and the natural process of grieving, reducing feelings of isolation or confusion.