Nokea
The nurse is caring for a client who is having surgery the next morning. The client says, 'I'm really scared about surgery. I've never been put to sleep before and I'm afraid I might not wake up.' Which response by the nurse is the most therapeutic?
- A. Why are you worried about such a minor procedure?
- B. We can call the doctor and cancel the surgery if you would prefer.
- C. It's normal to be afraid of something new like surgery. Tell me how you feel.
- D. Don't worry, you have a really good doctor and he will see to it that nothing goes wrong.
Correct Answer: C
Rationale: Acknowledging fear as normal and inviting the client to express feelings is therapeutic, fostering trust and emotional support.
You may also like to solve these questions
The nurse is caring for a client admitted to ICU following a heart attack. The nurse notes on the chart that the client has named his spouse to make decisions regarding his care if he is unable to speak for himself. What is the name of the document the client has signed? Fill in the blank.
- A. Living Will
- B. Do Not Resuscitate Order
- C. Durable Power of Attorney for Healthcare
- D. Advance Directive
Correct Answer: C
Rationale: The document is a **Durable Power of Attorney for Healthcare** or **Healthcare Proxy**, designating the spouse as the decision-maker.
The nurse is teaching a client with limited mobility about preventing blood clots. Which statement by the nurse is correct?
- A. Do not cross your legs when sitting.
- B. Avoid riding in a car for more than two hours.
- C. Put a pillow under your knees when lying in bed.
- D. You should ask your doctor to give you a blood thinner.
Correct Answer: A
Rationale: Crossing legs can impede venous return, increasing clot risk, so avoiding this is correct. Long car rides are a risk but not limited to two hours, and pillows under knees can worsen circulation.
The nurse is caring for a client who is 12 weeks pregnant and presented with the following symptoms: mild uterine cramping with spotting of blood. The cervical os is closed upon examination. How should the nurse chart the findings?
- A. missed miscarriage
- B. complete miscarriage
- C. inevitable miscarriage
- D. threatened miscarriage
Correct Answer: D
Rationale: Mild cramping, spotting, and a closed cervical os at 12 weeks indicate a threatened miscarriage, where the pregnancy may still continue.
All of the following are modifiable risk factors for coronary artery disease (CAD) EXCEPT
- A. high stress.
- B. obesity.
- C. smoking.
- D. family history.
Correct Answer: D
Rationale: Family history is a non-modifiable risk factor for CAD. Stress, obesity, and smoking can be modified through lifestyle changes.
The nurse is assessing elderly clients at a community center. Which of the following findings would be the most cause for concern?
- A. Complaint of dry mouth
- B. Loss of 1 inch of height in the last year
- C. Stiffened joints
- D. Rales bilaterally on chest auscultation
Correct Answer: D
Rationale: Rales bilaterally on chest auscultation suggest fluid in the lungs, which could indicate serious conditions like heart failure or pneumonia, requiring immediate attention. Dry mouth, height loss, and stiffened joints are common in aging but less urgent.