Nokea
During the initial interview of a patient, the nurse should: (Select all that apply.)
- A. assess the language capabilities of the patient.
- B. use open-ended questions.
- C. limit the interview to approximately 30 minutes.
- D. assess comprehension abilities of the patient.
Correct Answer: A
Rationale: The correct answer is A: assess the language capabilities of the patient. This is crucial to ensure effective communication and understanding. By assessing language capabilities, the nurse can tailor communication strategies appropriately. Option B is helpful but not as essential as language assessment. Option C is incorrect as the interview duration should be based on patient needs, not a set time limit. Option D is relevant, but assessing comprehension abilities alone may not be sufficient if language barriers exist.
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The nurse tells a patient, "For the last 2 days we have talked about whether to notify your daughter of your upcoming surgery in 2 days. You have indicated you do not want to be a burden to her, but you also would like to have her here. You may have to decide rather quickly because of the time constraint." The nurse is using the technique of:
- A. focusing.
- B. reflection.
- C. restatement.
- D. summarizing. Summarizing presents the problem and possible solutions with the attendant difficulties. This technique "unclutters" the problem and presents it back to the patient for his or her choice of a solution.
Correct Answer: D
Rationale: The correct answer is D: summarizing. Summarizing involves presenting the problem and potential solutions to the patient in a clear and concise manner. In this scenario, the nurse is summarizing the patient's thoughts and concerns about notifying their daughter of the upcoming surgery. By doing so, the nurse is helping the patient to make a decision by clarifying the situation and potential options. This technique allows the patient to reflect on the information presented and make an informed choice.
A: Focusing involves directing the conversation to a specific topic or issue.
B: Reflection involves restating the patient's feelings or thoughts to show understanding.
C: Restatement involves repeating the patient's words to confirm understanding.
Therefore, the correct answer is D because summarizing is the technique being used in this scenario to help the patient make a decision regarding notifying their daughter about the upcoming surgery.
The nurse cares for an adult client diagnosed with type 1 diabetes mellitus. Which is essential in building mutuality in the nurse3 client relationship?
- A. The nurse controls the relationship by retaining the power to make judgments about diabetes education.
- B. The nurse teaches diabetes management by involving the client in making decisions about self care.
- C. The nurse has expert knowledge of diabetes and formulates appropriate learning outcomes for the client.
- D. The nurse demonstrates trust and respect by solving problems for the client when issues occur with self-management.
Correct Answer: B
Rationale: The correct answer is B because it promotes mutual respect and collaboration in the nurse-client relationship. By involving the client in decision-making about self-care, the nurse empowers the client to take ownership of their health and fosters a sense of partnership. This approach enhances the client's autonomy and self-efficacy, leading to better adherence to the diabetes management plan.
Choice A is incorrect as it implies a power dynamic where the nurse controls the relationship, which can hinder trust and collaboration. Choice C is incorrect because while expert knowledge is valuable, it does not necessarily build mutuality unless shared in a collaborative manner. Choice D is incorrect as solving problems for the client may undermine their ability to develop problem-solving skills and independence in managing their condition.
The nurse plans to use self-disclosure to aid a mother and father in the grieving process after the death of their child. The steps of a helpful self-disclosure appear below. What is the first step?
- A. Succinctly share a personal experience that is a similar grieving experience.
- B. Listen to the parents talk about their child and observe their movements and gestures.
- C. Reflect upon the parent's statements to communicate understanding.
- D. Seek verification that the self-disclosure was helpful to the child's parents.
Correct Answer: B
Rationale: The correct answer is B: Listen to the parents talk about their child and observe their movements and gestures. This is the first step in helpful self-disclosure because it allows the nurse to understand the parents' emotions and experiences before sharing their own. By actively listening and observing, the nurse can establish a connection with the parents and demonstrate empathy. This step sets the foundation for effective communication and builds trust between the nurse and the parents.
Incorrect choices:
A: Succinctly share a personal experience that is a similar grieving experience. This is not the first step because it doesn't consider the parents' feelings and might come across as insensitive or self-centered.
C: Reflect upon the parent's statements to communicate understanding. While reflection is important, it should come after active listening to ensure the nurse fully grasps the parents' emotions.
D: Seek verification that the self-disclosure was helpful to the child's parents. Seeking verification should come at a later stage after the nurse has provided support and guidance through
The hospital nurse educator develops an educational session for staff nurses on how to clearly record data in a patient's electronic medical record. Which key point should the nurse educator include in the teaching plan? (Select all that apply)
- A. A patient who is at high risk for falls will require more frequent documentation.
- B. The nurse should avoid labels (e.g., good, drug seeking, and lazy) to describe patients.
- C. Detailed and specific documentation is only required if a malpractice suit is expected.
- D. Each entry by the nurse in the electronic medical record should be clear and concise.
Correct Answer: A
Rationale: The correct answer is A because documenting the frequency of assessments and interventions for high-risk patients, such as those at risk for falls, is crucial for patient safety and care coordination. By documenting more frequently for high-risk patients, nurses can ensure timely interventions and prevent adverse events. This practice aligns with the principles of patient-centered care and risk management.
Choices B, C, and D are incorrect:
B: Avoiding labels in documentation is important for professionalism and ethical practice, but it is not directly related to the frequency of documentation for high-risk patients.
C: Detailed and specific documentation is required for all patients to ensure comprehensive care, not just for potential malpractice suits.
D: While clear and concise documentation is essential, this choice does not specifically address the need for more frequent documentation for high-risk patients.
The nurse cares for a client who does not follow dietary recommendations for treatment of heart failure. Which statement, if made by the nurse, demonstrates respect for the client?
- A. "It doesn't make any difference to me whether you decide to eat healthy or not.=
- B. "You will get more attention from your physician, if you follow diet restrictions.=
- C. "I care about you even if you are not following your dietary restrictions.=
- D. "Have you noticed that patients who eat healthy foods receive better healthcare?=
Correct Answer: C
Rationale: The correct answer is C because it demonstrates empathy and respect for the client's autonomy. By stating "I care about you even if you are not following your dietary restrictions," the nurse acknowledges the client's choice while still showing concern for their well-being. This response fosters a supportive and non-judgmental relationship with the client.
Choices A, B, and D are incorrect because they either show indifference, use coercion, or imply a comparison between patients based on their dietary choices. These responses do not prioritize the client's feelings, choices, or autonomy, which is essential in providing patient-centered care.