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The nurse cares for the mother of a child who died in the emergency room as a result of an accidental poisoning. Which response by the nurse is appropriate?
- A. Place a greater emphasis on nonverbal aspects of empathy over verbal.
- B. Accurately reflect on the mother's feelings to convey understanding and concern.
- C. Repeat exact phrases stated by the mother to aid in expressions of grief.
- D. Reflect on the expressed feelings of the mother but with the nurse's own words.
Correct Answer: B
Rationale: The correct answer is B because accurately reflecting on the mother's feelings shows understanding and empathy, validating her emotions. This approach helps establish trust and connection, essential in providing emotional support.
A: Placing greater emphasis on nonverbal aspects may not effectively convey empathy and understanding.
C: Merely repeating exact phrases may come off as insincere and robotic, lacking genuine empathy.
D: Reflecting on the mother's feelings using the nurse's own words may not accurately capture the depth of the mother's emotions and may lead to misinterpretation.
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The author describes the patient journey as driving down a country road and somehow getting lost. At that moment and time, all that is needed is clear directions about how to get to your destination, not about types of entertainment in the area. The same is true for patients. Accordingly, a part of each nursing assessment should include:
- A. Patient's need for information and level of understanding
- B. Detailed overview of disease process
- C. Specific examples from other patients with same disease
- D. Nurse's feelings about newest treatment modality
Correct Answer: A
Rationale: Step 1: Understanding the patient's need for information and level of understanding is crucial to providing appropriate care.
Step 2: Clear directions are necessary to guide patients, just like clear information is needed to guide their healthcare decisions.
Step 3: Assessing the patient's need for information helps tailor education to their level of understanding.
Step 4: This choice directly aligns with the analogy of providing clear directions for patients on their healthcare journey.
Summary: Choice A is correct as it emphasizes the importance of assessing the patient's need for information and understanding, which is essential for guiding them effectively. Choices B, C, and D are incorrect as they do not directly address the patient's need for information and understanding in the analogy provided.
The nurse prepares to obtain a health history from a hospitalized patient. Which action by the nurse is appropriate?
- A. Set time limits for the interview to reduce cost.
- B. Avoid asking questions that may upset the patient.
- C. Respect the patient's privacy by closing the door.
- D. Stand at the foot of the bed to maintain eye contact.
Correct Answer: C
Rationale: The correct answer is C: Respect the patient's privacy by closing the door. Closing the door ensures confidentiality and privacy during the health history interview. This step is crucial to maintain the patient's dignity and foster trust. Setting time limits (choice A) may compromise the quality of the assessment. Avoiding upsetting questions (choice B) may hinder the gathering of important information. Standing at the foot of the bed for eye contact (choice D) is not appropriate as it may seem confrontational and uncomfortable for the patient.
A patient is attracted to the nurse and attempts to initiate a social relationship. It is most appropriate for the nurse to take which action?
- A. Encourage the client's behavior to develop a trusting nurse–client relationship.
- B. Inform the charge nurse of the situation and ask for a different patient assignment.
- C. Tell the patient that the relationship must remain professional at all times.
- D. Determine if the patient can be transferred to another nursing care unit.
Correct Answer: C
Rationale: The correct answer is C. It is crucial for healthcare professionals to maintain professional boundaries with patients to ensure ethical practice and prevent potential harm. By telling the patient that the relationship must remain professional, the nurse sets clear boundaries and maintains the integrity of the therapeutic relationship. This approach protects both the patient and the nurse from potential ethical violations.
Choice A is incorrect because encouraging the behavior could lead to boundary violations and harm the therapeutic relationship. Choice B is not the most appropriate immediate action as it does not address the situation directly with the patient. Choice D is also not the best course of action as transferring the patient does not address the underlying issue of maintaining professional boundaries.
The nurse cares for a patient who becomes confused and a vest restraint is applied. The nurse should take which action when notifying the patient's family?
- A. Avoid discussing the treatment plan to reduce anxiety and worry.
- B. Ask another nurse who has rapport with the family to be present.
- C. Use medical terms to demonstrate competence.
- D. Assume that the family wants a detailed explanation.
Correct Answer: B
Rationale: The correct answer is B because having another nurse who has a good relationship with the family present can help facilitate effective communication and address any concerns or questions the family may have. This approach can help build trust and provide emotional support during a potentially difficult situation.
A: Avoiding discussing the treatment plan can lead to confusion and distrust.
C: Using medical terms may confuse or intimidate the family and hinder effective communication.
D: Assuming the family wants a detailed explanation may not be accurate and can result in information overload.
The nurse cares for a patient who is scheduled for abdominal surgery. Which action, if taken by the nurse, is most appropriate?
- A. Mandate the use of a complementary therapy such as guided imagery.
- B. Administer opioids for pain rated more than 3 (on a 0 to 10 pain scale).
- C. Ask the patient about expectations for postoperative pain management.
- D. Provide pain management based on a standardized nursing care plan.
Correct Answer: C
Rationale: The correct answer is C. Asking the patient about expectations for postoperative pain management is most appropriate as it involves assessing the patient's preferences and needs, ensuring individualized care. Option A is incorrect as mandating complementary therapy may not align with the patient's preferences or needs. Option B is incorrect as administering opioids based solely on pain rating may not consider individual variations in pain tolerance. Option D is incorrect as providing pain management solely based on a standardized care plan may not address the patient's specific needs and preferences.