Nokea
Critical thinking in the expert nurse is greatly enhanced by opportunities to:
- A. apply theory in real situations.
- B. work with physicians to provide patient care.
- C. follow physician orders in providing patient care.
- D. develop nursing diagnoses for commonly occurring illnesses.
Correct Answer: A
Rationale: The correct answer is A because applying theory in real situations allows nurses to analyze, evaluate, and problem-solve effectively. This promotes critical thinking by integrating knowledge into practice. Working with physicians (B) and following orders (C) do not directly enhance critical thinking as they focus more on collaboration and task completion. Developing nursing diagnoses (D) is important but does not specifically target critical thinking skills like applying theory does.
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A 65-year-old man with emphysema and bronchitis has come to the clinic for a follow-up appointment. On assessment of his skin, the nurse would expect to find which of the following?
- A. Anasarca.
- B. Scleroderma.
- C. Pedal erythema.
- D. Clubbing of the nails.
Correct Answer: D
Rationale: The correct answer is D: Clubbing of the nails. Clubbing is a physical finding associated with chronic respiratory conditions like emphysema and bronchitis. It is characterized by the softening of the nail bed and the loss of the normal angle between the nail and the nail bed. This occurs due to chronic hypoxia and can be a sign of advanced lung disease. Anasarca (choice A) is generalized edema, not specific to respiratory conditions. Scleroderma (choice B) is a connective tissue disorder affecting the skin and other organs, not directly related to respiratory conditions. Pedal erythema (choice C) refers to redness of the feet and is not a typical finding in emphysema or bronchitis.
A nurse is teaching a patient about managing chronic obstructive pulmonary disease (COPD). Which of the following statements by the patient indicates the need for further education?
- A. I should avoid exposure to second-hand smoke.
- B. I will take my medications as prescribed.
- C. I can stop using my inhaler once I feel better.
- D. I will practice breathing exercises to improve my lung function.
Correct Answer: C
Rationale: The correct answer is C because stopping the inhaler once feeling better is incorrect. Inhalers are used to manage COPD symptoms long-term, not just when feeling unwell. Step 1: Explain that inhalers are essential for managing COPD and should be used consistently. Step 2: Emphasize that stopping inhaler use prematurely can lead to exacerbation of symptoms and worsening of the condition. Step 3: Reinforce the importance of following the prescribed treatment plan for optimal COPD management. Other choices are incorrect: A: True, avoiding second-hand smoke is crucial for COPD management. B: True, taking medications as prescribed is essential. D: True, breathing exercises can help improve lung function.
A nurse is caring for a patient with chronic heart failure. The nurse should monitor for which of the following signs of worsening heart failure?
- A. Fatigue and shortness of breath.
- B. Increased urine output.
- C. Decreased blood pressure.
- D. Pitting edema and weight gain.
Correct Answer: D
Rationale: The correct answer is D: Pitting edema and weight gain. In chronic heart failure, worsening symptoms indicate fluid retention. Pitting edema in the extremities and weight gain are signs of fluid overload, indicating worsening heart failure. It is crucial for the nurse to monitor these signs to prevent exacerbation. Fatigue and shortness of breath (Choice A) are common symptoms in heart failure but not specific to worsening condition. Increased urine output (Choice B) is not typically seen in worsening heart failure as the kidneys may be compromised. Decreased blood pressure (Choice C) can occur in acute decompensation but is not a consistent sign of worsening chronic heart failure.
During her prenatal checkup, a patient begins to cry as the nurse asks her about previous pregnancies. The patient says that she is remembering her last pregnancy, which ended in miscarriage. The nurse's best response to her crying would be:
- A. "I'm so sorry for making you cry!"
- B. "I can see that you are sad remembering this. It is all right to cry."
- C. "Why don't I step out for a few minutes until you're feeling better?"
- D. "I can see that you feel sad about this; why don't we talk about something else?"
Correct Answer: B
Rationale: The correct answer is B because it shows empathy and validation towards the patient's emotions. By acknowledging the patient's sadness and giving her permission to cry, the nurse creates a safe and supportive environment. This response helps the patient feel understood and accepted, facilitating emotional expression and potentially leading to a deeper therapeutic relationship.
Choice A is incorrect because it focuses on the nurse's discomfort rather than the patient's feelings. Choice C is incorrect as it may come across as dismissive of the patient's emotions. Choice D is incorrect as it suggests avoiding the topic rather than addressing the patient's feelings directly.
During an interview with a patient, at which distance would the nurse expect that most of the interview will take place?
- A. 1 m
- B. 1.5 m
- C. 2 m
- D. 3 m
Correct Answer: B
Rationale: The correct answer is B: 1.5 m. This distance is known as the personal distance in communication, where most interviews take place. Personal distance allows for a comfortable level of interaction without invading personal space. Choice A (1 m) is too close and may make the patient uncomfortable. Choice C (2 m) is too far for an intimate interview setting. Choice D (3 m) is too distant and may lead to a lack of connection and understanding during the interview. Overall, B is the best choice for a nurse-patient interview to ensure a respectful and effective conversation.