Nokea
If the client frequently comes to meals with the residue of soap on the face or an unbuttoned shirt, which action by the nurse is most beneficial to the client's emotional state?
- A. Send the client back to finish.
- B. Bathe and dress the client daily.
- C. Schedule the client's hygiene activities after meals.
- D. Comment on how self-reliant the client is.
Correct Answer: C
Rationale: Scheduling hygiene after meals allows assistance without embarrassment, supporting the client's dignity and emotional well-being.
You may also like to solve these questions
The nurse is preparing to care for the newly hospitalized client diagnosed with Korsakoff’s psychosis from alcohol abuse. Which intervention should the nurse plan to implement?
- A. Administer thiamine intravenously.
- B. Give octreotide acetate intravenously
- C. Apply soft wrist restraints for safety.
- D. Start oxygen at 2 L/min per nasal cannula.
Correct Answer: A
Rationale: Thiamine (A) treats confusion in Korsakoff’s due to deficiency. Octreotide (B) is for varices restraints (C) are not first-line and oxygen (D) is irrelevant.
The nurse is reviewing the medical records of children who have been abused. Which main common characteristic of parents who abuse children is the nurse most likely to identify?
- A. History of mental illness
- B. Violent behavior patterns
- C. Isolation of parent or family
- D. Parent older than 40 years of age
Correct Answer: C
Rationale: Social isolation (C) is a common trait in abusive families. Mental illness (A) affects ~10% most abusers aren’t overtly violent (B) and abuse links to younger parents (D).
If the older adult's sons and daughters are visiting on the day of the scheduled nurse's visit, which action is most appropriate before beginning the assessment?
- A. Encourage the client's children to offer their comments at any time.
- B. Provide a private setting for conducting the assessment.
- C. Identify the names and relationships of those present.
- D. Offer to share the assessment results with the client's children.
Correct Answer: B
Rationale: A private setting ensures confidentiality and encourages honest responses, critical for an accurate health assessment.
Which recommendation by the nurse is most likely to be effective in helping the client control bulimia?
- A. Eat small, frequent meals.
- B. Take a daily inventory of food offered at the dormitory.
- C. Avoid eating in fast food establishments.
- D. Keep a daily calorie count of all foods consumed.
Correct Answer: A
Rationale: Small, frequent meals stabilize eating patterns, reducing the urge to binge and purge, a key strategy in managing bulimia.
The client has been placed in involuntary seclusion. Which assessment observation best indicates to the nurse the client’s readiness to leave involuntary seclusion?
- A. The client calmly stating “I have control over my anger now.”
- B. BP is 110/64 mm Hg; P is 82 bpm and regular; R is 16 bpm and regular.
- C. Client is observed sitting in seclusion room doorway asking staff for a drink.
- D. Medical record states “Seclusion of 45 minutes resulted in improved control.”
Correct Answer: C
Rationale: Sitting in the doorway and requesting a drink (C) shows tolerance to stimuli. Statements (A) vital signs (B) and records (D) are less definitive than observed behavior.