Nokea
Let me know how you're doing and whether you need any help."
- A. "Give the patient in 204A a shower after breakfast, and call me to check her feet before you get her dressed."
- B. "Take the vital signs on all the patients in the lounge and tell me whether there are problems." The clarity and brevity of the direction makes the delegated task clear and leaves the responsibility of assessment to the nurse.
Correct Answer: B
Rationale: The correct answer is B because it provides clear instructions to take vital signs on all patients in the lounge and report any problems. This ensures comprehensive assessment and communication. Choice A is incorrect because it lacks specificity and may lead to overlooking important tasks. Choice C and D are incorrect as they are blank. Providing clear and concise directions is crucial in delegation to ensure tasks are completed accurately and efficiently.
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A teacher at a local elementary school asks a nurse to talk to the students about nutrition. Which response by the nurse is most appropriate?
- A. "I will teach the students how to read nutrition labels.=
- B. "What would you like the students to learn about nutrition?=
- C. "The students need to know about the consequences of obesity.=
- D. "I will enjoy teaching the students everything I know about nutrition.=
Correct Answer: B
Rationale: The correct answer is B because it shows the nurse's willingness to understand the teacher's specific objectives and tailor the nutrition talk accordingly. This approach ensures that the nurse addresses the teacher's concerns and meets the students' needs effectively.
Explanation for why the other choices are incorrect:
A: Teaching students how to read nutrition labels may be important, but it assumes that this is the teacher's primary goal without confirming it first.
C: Focusing on the consequences of obesity may not align with the teacher's desired focus on general nutrition education.
D: While enthusiasm for teaching is positive, this response does not address the teacher's specific request for the nutrition talk.
A patient who has had a stroke is unable to speak clearly and has right sided hemiplegia. The nurse will design the approach to the assessment interview by:
- A. asking questions and explaining procedures to the patient's daughter.
- B. speaking slowly and giving the patient time to respond.
- C. telling the patient he will get all necessary information from the daughter.
- D. prompting the answers and finishing the sentences for the patient. Speaking slowly recognizes that the patient may process (if able) information more slowly.
Correct Answer: B
Rationale: The correct answer is B because speaking slowly and giving the patient time to respond allows the patient with speech difficulties due to the stroke to process information and formulate a response. Prompting or finishing sentences can hinder the patient's ability to communicate independently. Asking questions to the patient directly, rather than relying on a family member, ensures accurate information is obtained directly from the patient. Telling the patient that all information will come from the daughter undermines the patient's autonomy and may lead to incomplete or inaccurate information.
A patient reports to the nurse, "My doctor is not doing anything about my pain." Which response by the nurse is assertive and expresses warmth?
- A. "If I were you, I would see a different doctor."
- B. "What you really mean is you do not like your doctor."
- C. "It is wrong for you to blame your doctor."
- D. "You seem frustrated with your doctor."
Correct Answer: D
Rationale: The correct answer is D because it acknowledges the patient's feelings without judgment and expresses empathy. The nurse reflects the patient's emotions by stating, "You seem frustrated with your doctor," showing understanding. Option A is dismissive, suggesting the patient change doctors. Option B assumes the patient's feelings and could come off as confrontational. Option C is accusatory and could make the patient defensive. Overall, option D is assertive, warm, and empathetic, making it the best response in this situation.
According to the NCSBN, appropriate self-disclosure is a part of maintaining professional boundaries. Appropriate self-disclosure includes the following:
- A. Discussing intimate or personal values with patients
- B. Keeping secrets with a patient or for a patient
- C. Expressing you are the only one who truly understands patient
- D. Brief, focused, and only used if experience is similar
Correct Answer: D
Rationale: The correct answer is D because appropriate self-disclosure in a therapeutic setting should be brief, focused, and only shared if it enhances the therapeutic relationship. This helps maintain professional boundaries and keeps the focus on the patient's needs. Choice A is incorrect because discussing intimate or personal values with patients can blur boundaries and shift the focus away from the patient. Choice B is incorrect because keeping secrets with or for a patient can lead to ethical dilemmas and compromise trust. Choice C is incorrect because expressing that you are the only one who truly understands the patient can create a power imbalance and hinder the therapeutic process.
Which demonstrates the nurse's genuine concern for clients?
- A. Tell a patient who has a terminal illness that everything will be fine.
- B. Delay notifying the patient about the death of a dependent child.
- C. Provide a placebo to a patient in severe pain to assess for substance abuse.
- D. Inform the patient about a medication error along with symptoms to report.
Correct Answer: D
Rationale: The correct answer is D because informing the patient about a medication error and symptoms to report shows transparency, honesty, and prioritizes patient safety. This action also promotes trust in the nurse-patient relationship.
A: Choice A is incorrect because falsely reassuring a terminally ill patient does not demonstrate genuine concern and lacks honesty.
B: Choice B is incorrect because delaying important information about the death of a dependent child is unethical and can cause unnecessary distress to the patient.
C: Choice C is incorrect because providing a placebo without informed consent violates ethical principles and does not prioritize the patient's well-being.