Nokea
The nurse is reviewing Mr. N's (non-Hodgkin lymphoma) medication administration record and sees that the combination therapy aprepitant, dexamethasone, and ondansetron was administered during the last shift. What is the nurse most likely to ask to determine efficacy of the therapy?
- A. "On a scale of 1 to 10, with 1 being the least and 10 being the worst, what number is your pain? Where is the pain located?"
- B. "Have the medications improved your appetite? Are there special foods that you would prefer?"
- C. "Are you having any feelings of nausea right now? When was the last time you vomited?"
- D. "After taking the medications, have you experienced any improvement in your energy level? Do you feel fatigued?"
Correct Answer: C
Rationale: The correct answer is C. The nurse would ask about feelings of nausea and vomiting to determine the efficacy of the antiemetic therapy. Nausea and vomiting are common side effects of chemotherapy, which Mr. N would receive for non-Hodgkin lymphoma. Improvement in these symptoms indicates the effectiveness of the antiemetic regimen. Choices A, B, and D are not directly related to the medications administered and would not provide valuable information on the efficacy of the therapy for managing chemotherapy-induced nausea and vomiting. Option A focuses on pain assessment, B on appetite and food preferences, and D on energy levels and fatigue, which are not the primary outcomes to evaluate in this context.
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The home health nurse cares for a patient who is diagnosed with chronic obstructive pulmonary disease. Which response(s) and behavior(s) by the nurse would indicate that bonding between nurse and patient has occurred? (Select all that apply)
- A. Expects the patient to meet the goals for exercise as determined by the nurse.
- B. Listens to the patient describe the feelings of anxiety related to severe dyspnea.
- C. Develops teaching plan based on the learning preferences of the patient.
- D. Refrains from touching the patient unless performing physical assessment techniques.
Correct Answer: B
Rationale: The correct answer is B because actively listening to the patient describe their feelings of anxiety related to severe dyspnea demonstrates empathy and a deeper connection between the nurse and patient. This behavior shows understanding and support, fostering trust and rapport. It indicates that the nurse is attentive to the patient's emotional needs, which is essential for effective care in chronic conditions like COPD.
Option A is incorrect because expecting the patient to meet exercise goals set by the nurse does not necessarily indicate bonding. It may reflect a more authoritative approach rather than a collaborative relationship. Option C, while important for individualized education, does not specifically indicate bonding unless it involves understanding the patient's preferences on a personal level. Option D is incorrect because refraining from touching the patient may be necessary in some situations, but it does not directly relate to establishing a bond.
The nurse cares for a patient who has type 2 diabetes mellitus and does not consistently follow the dietary restrictions and exercise recommendations. The patient takes a daily oral hypoglycemic agent as prescribed. Which statement by the nurse is most appropriate?
- A. "It is great that you take your medicine as prescribed."
- B. "It wouldn't be that hard to walk a few blocks every other day."
- C. "You are definitely not one of my good patients."
- D. "It is a waste of time to help you because you will never change."
Correct Answer: A
Rationale: Correct Answer: A
Rationale:
1. Acknowledges adherence to medication, reinforcing positive behavior.
2. Encourages patient compliance without judgment or criticism.
3. Focusing on the patient's effort in taking medication can lead to discussions about improving other aspects of diabetes management.
Summary:
B: While exercise is important, this choice may come across as dismissive and not addressing the patient's current behavior.
C: This choice is judgmental and may damage the therapeutic relationship.
D: This choice is defeatist and does not promote any positive change or motivation.
Which describes characteristics of mutuality in the nurse3client relationship? (Select all that apply)
- A. Dependency
- B. Collaboration
- C. Paternalism
- D. Acceptance of differences
Correct Answer: B
Rationale: The correct answer is B: Collaboration. Mutuality in the nurse-client relationship involves working together as partners towards shared goals, with both parties contributing equally. Collaboration fosters empowerment, respect, and shared decision-making. Dependency (A) implies an unequal power dynamic, which is not characteristic of mutuality. Paternalism (C) involves a one-sided decision-making process, conflicting with the collaborative nature of mutuality. Acceptance of differences (D) is important but does not solely define mutuality. In summary, collaboration best reflects the principles of mutuality by emphasizing partnership, equality, and shared responsibility.
A Hispanic patient approaches the Asian nurse and, standing very close, touches the nurse's shoulder during their conversation. The nurse begins to step back to 18 to 24 inches, while smiling and nodding to the patient. This situation is most likely an example of:
- A. the nurse's need to maintain a professional role rather than a social role.
- B. a patient's attempt to keep the nurse's attention.
- C. a nurse's need to establish a more appropriate location for conversation.
- D. a difference in culturally learned personal space of the nurse and the patient.
Correct Answer: D
Rationale: The correct answer is D: a difference in culturally learned personal space of the nurse and the patient. This is because different cultures have varying norms regarding personal space. In this scenario, the Hispanic patient touching the Asian nurse's shoulder and standing very close suggests a cultural difference in personal space expectations. The nurse stepping back to establish a distance of 18 to 24 inches is a respectful response to accommodate the patient's cultural norm. It demonstrates cultural competence and understanding.
Explanation for why the other choices are incorrect:
A: the nurse's need to maintain a professional role rather than a social role - This choice does not address the cultural aspect of personal space and assumes the nurse's response is solely professional.
B: a patient's attempt to keep the nurse's attention - This choice does not consider the cultural factor influencing the patient's behavior.
C: a nurse's need to establish a more appropriate location for conversation - This choice does not acknowledge the cultural difference in personal space as the primary reason for the nurse
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.