Nokea
At what point in the nurse-client relationship should termination first be addressed?
- A. in the working phase
- B. in the termination phase
- C. in the orientation phase
- D. when the client initially brings up the topic
Correct Answer: C
Rationale: The client has a right to know the parameters of the nurse-client relationship. If the relationship is to be time limited, the client should be informed of the number of sessions. If it is open-ended, the termination date is not known at the outset, and the client should know that this is an issue that is negotiated at a later date.
You may also like to solve these questions
A nurse is assessing a patient in the ICU. The patient has the following signs: weak pulse, quick respiration, acetone breath, and nausea. Which of the following conditions is most likely occurring?
- A. Hypoglycemic patient
- B. Hyperglycemic patient
- C. Cardiac arrest
- D. End-stage renal failure
Correct Answer: B
Rationale: All of the clinical signs indicate a hyperglycemic condition.
The LPN is preparing to clean a client's PEG tube. Which of the following tasks should the nurse perform? A. Gently remove crusty drainage from the site. B. Pull the tube in multiple directions to ensure it is secure. C. Thoroughly dry the skin around the tube site with a clean towel. D. Use mild soap to clean around the tube site. E. Apply talcum powder to the tube site.
- A. B, D, E
- B. A, B, C
- C. A, C, D
- D. C, D, E
Correct Answer: C
Rationale: LPNs caring for the PEG tube should be careful to not disrupt the tube, pull on the tube, or apply any ointment or powder near or on the tube. Talcum powder may irritate the stoma.
Physical examination of a client regarding mobility status should:
- A. begin with gait.
- B. be oriented to time, place, and person.
- C. begin with the Romberg test.
- D. begin with the Tandem Walk test.
Correct Answer: A
Rationale: Gait is usually assessed as the client walks into the room. Normal gait is smooth, flowing, and rhythmic without assistive devices.
The client is in skeletal traction with 20 lb of traction applied to a right lower leg fracture. Which intervention should the nurse perform at regular intervals?
- A. Perform pin site care
- B. Remove the weights
- C. Reposition the right leg
- D. Perform passive ROM to the legs
Correct Answer: A
Rationale: A: Regular pin site care prevents infection. B: Weights are only removed in emergencies. C: Repositioning disrupts alignment. D: ROM is avoided to maintain traction.
The greatest time savers when planning client care include all of the following except:
- A. reacting to the crisis of the moment.
- B. setting goals.
- C. planning.
- D. specifying priorities.
Correct Answer: A
Rationale: The greatest time-savers when planning client care are activities that facilitate focus and completion of priority items. Time-savers include setting goals, establishing priorities, planning tasks, delegating where appropriate, re-assessment, and ongoing evaluation of needs.