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The nurse provides care for a male patient. When the nurse addresses the patient, which would be most appropriate?
- A. Use both first and last name with each encounter.
- B. Ask the patient how he prefers to be addressed.
- C. Call the patient by his first name.
- D. Address the patient by his last name.
Correct Answer: B
Rationale: The correct answer is B: Ask the patient how he prefers to be addressed. This approach respects the patient's autonomy and personal preferences, promoting patient-centered care. By asking the patient directly, the nurse acknowledges the patient's individuality and ensures respectful communication.
A: Using both first and last name with each encounter may come across as too formal or impersonal for some patients, potentially creating a barrier in the nurse-patient relationship.
C: Calling the patient by his first name without consent may be perceived as too familiar or disrespectful by some patients, leading to discomfort or a lack of trust in the nurse.
D: Addressing the patient by his last name may be too formal for some patients and can create a sense of distance or hierarchy in the nurse-patient relationship.
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Ms. C (bowel resection) repeatedly refuses to perform a return demonstration of any aspect of colostomy care. Despite steady improvement and independent resumption of other ADLs, she protests, "I'm too weak. You'll have to do it for me." At this point, what is the priority nursing concept to consider in planning interventions for Ms. C?
- A. Mobility
- B. Tissue integrity
- C. Functional ability
- D. Coping
Correct Answer: C
Rationale: The correct answer is C: Functional ability. This is because the priority nursing concept to consider in planning interventions for Ms. C is her ability to independently perform colostomy care. By refusing to demonstrate, she may be indicating a lack of functional ability to manage this aspect of self-care. This is essential for her long-term independence and quality of life. Mobility (choice A) is important but not the priority in this case. Tissue integrity (choice B) is also crucial but not as immediate as ensuring functional ability. Coping (choice D) is important for emotional well-being but does not address the primary issue of functional ability for self-care.
The nurse tells a patient, "For the last 2 days we have talked about whether to notify your daughter of your upcoming surgery in 2 days. You have indicated you do not want to be a burden to her, but you also would like to have her here. You may have to decide rather quickly because of the time constraint." The nurse is using the technique of:
- A. focusing.
- B. reflection.
- C. restatement.
- D. summarizing. Summarizing presents the problem and possible solutions with the attendant difficulties. This technique "unclutters" the problem and presents it back to the patient for his or her choice of a solution.
Correct Answer: D
Rationale: The correct answer is D: summarizing. Summarizing involves presenting the problem and potential solutions to the patient in a clear and concise manner. In this scenario, the nurse is summarizing the patient's thoughts and concerns about notifying their daughter of the upcoming surgery. By doing so, the nurse is helping the patient to make a decision by clarifying the situation and potential options. This technique allows the patient to reflect on the information presented and make an informed choice.
A: Focusing involves directing the conversation to a specific topic or issue.
B: Reflection involves restating the patient's feelings or thoughts to show understanding.
C: Restatement involves repeating the patient's words to confirm understanding.
Therefore, the correct answer is D because summarizing is the technique being used in this scenario to help the patient make a decision regarding notifying their daughter about the upcoming surgery.
the HCP because the client deserves to have adequate pain relief.
- A. Wait until the change of medication occurs and then monitor the client's response.
Correct Answer: A
Rationale: The correct answer is A because it demonstrates a proactive approach to ensuring the client receives adequate pain relief. By waiting until the medication change occurs and then monitoring the client's response, the healthcare provider can assess the effectiveness of the new medication and make any necessary adjustments promptly. This approach prioritizes the client's well-being by addressing their pain management needs in a timely and thorough manner. Choices B, C, and D are not as effective as they do not involve actively monitoring the client's response to the medication change, which is crucial in ensuring optimal pain relief for the client.
The nurse is interviewing a Native American client. It is most important for the nurse to take which action?
- A. Maintain eye contact to show respect and interest.
- B. Assess whether the client is comfortable with eye contact.
- C. Avoid prolonged eye contact with this client.
- D. Sit next to the patient to avoid any eye contact.
Correct Answer: B
Rationale: The correct answer is B: Assess whether the client is comfortable with eye contact. This is important because different cultures have varying views on eye contact, and it is crucial to respect the client's preferences. By assessing the client's comfort level with eye contact, the nurse can establish rapport and demonstrate cultural sensitivity.
A: Maintaining eye contact may not be culturally appropriate for some Native American clients, so it is important to assess their comfort level first.
C: Avoiding prolonged eye contact assumes all Native American clients have the same preferences, which is not accurate.
D: Sitting next to the patient to avoid eye contact may be perceived as distancing or disrespectful in some cultures.
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.