Nokea
The team leader is reviewing the pain management plan for Mr. U. He is having significant pain related to the cancer and the pulmonary resection. Which option would be the best for Mr. U?
- A. Mr. U is instructed to ask for pain medication whenever he needs it.
- B. Mr. U is to receive around-the-clock fixed doses of opioid analgesics.
- C. Mr. U should be offered the nonopioid medication first to see it if works.
- D. Mr. U has a high risk for respiratory distress, so opioids are not prescribed.
Correct Answer: B
Rationale: The correct answer is B because Mr. U is experiencing significant pain related to cancer and pulmonary resection, which typically requires continuous pain management. Around-the-clock fixed doses of opioid analgesics provide consistent pain relief and can be adjusted based on his pain levels. This approach ensures adequate pain control without the need for Mr. U to wait until the pain becomes severe before asking for medication. Option A may lead to undertreatment of pain. Option C delays effective pain relief for Mr. U who is already experiencing significant pain. Option D is incorrect as opioids can be safely administered with proper monitoring, even in patients at high risk for respiratory distress.
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The nurse is caring for a patient who states, "I tossed and turned last night." The nurse responds to the patient, "You feel like you were awake all night?" This is an example of:
- A. open-ended question.
- B. restatement.
- C. reflection.
- D. offering self. Restatement is a
Correct Answer: B
Rationale: The correct answer is B: restatement. Restatement involves repeating the patient's words to confirm understanding. In this scenario, the nurse echoed the patient's statement to show empathy and acknowledge the patient's feelings. This technique helps build rapport and fosters therapeutic communication.
Explanation of why other choices are incorrect:
A: Open-ended question: This involves encouraging the patient to elaborate on their feelings or experiences, not just repeating what the patient said.
C: Reflection: This involves restating the patient's feelings to show understanding, not simply repeating their words.
D: Offering self: This involves offering oneself to the patient for support, which was not demonstrated in the scenario.
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 nurse3client 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 because it maintains professional boundaries, prioritizing the patient's well-being. By clearly stating that the relationship must remain professional, the nurse sets clear boundaries and avoids any potential ethical issues. Choice A is incorrect as it can lead to boundary violations and compromise patient care. Choice B is incorrect as it does not address the situation directly and may not be necessary if proper boundaries are set. Choice D is incorrect as transferring the patient may not address the underlying issue and is not a standard response to this situation.
The nurse recognizes a verbal response when the patient:
- A. nods her head when asked whether she wants juice.
- B. writes the answer to a question asked by the nurse.
- C. begins sobbing uncontrollably when asked about her daughter.
- D. is moaning and restless and appears to be in pain. Verbal communication involves words, either written or spoken. Nodding, sobbing, and moaning are nonverbal communication.
Correct Answer: B
Rationale: Step-by-step rationale:
1. Verbal communication involves words, either written or spoken.
2. Choice B states that the patient writes the answer to a question asked by the nurse, which involves using words.
3. Therefore, choice B correctly represents verbal communication.
4. Choices A, C, and D involve nonverbal communication methods such as nodding, sobbing, and moaning, which do not involve words.
The nurse is caring for a client who is diagnosed with type 1 diabetes mellitus. Which nursing action would most likely improve client compliance with the therapeutic regimen?
- A. Consistently ignore negative statements made by the client.
- B. Avoid touching the client to reduce tension and uneasiness.
- C. Focus on the physical aspects of care such as insulin administration.
- D. Listen attentively to the client's perception of having a chronic illness.
Correct Answer: D
Rationale: The correct answer is D because listening attentively to the client's perception of having a chronic illness is crucial for building a therapeutic relationship and understanding their concerns, fears, and challenges. By actively listening, the nurse can address the client's emotional and psychological needs, which are essential in managing a chronic condition like type 1 diabetes. This approach fosters trust, enhances communication, and promotes client engagement in their treatment plan.
Choices A, B, and C are incorrect because ignoring negative statements, avoiding physical contact, and solely focusing on the physical aspects of care can lead to poor client-nurse communication, lack of trust, and ultimately hinder compliance with the therapeutic regimen. Ignoring negative statements may escalate resistance, avoiding physical contact may create distance, and solely focusing on physical care neglects the holistic needs of the client.
The nurse cares for a client who has several options for cancer treatment. Which document supports the client's right to have access to information about treatment options?
- A. The Standards of Clinical Practice
- B. An Advance Health Care Directive
- C. The Patient's Bill of Rights
- D. A Client's Living Will
Correct Answer: C
Rationale: The correct answer is C: The Patient's Bill of Rights. This document supports the client's right to access information about treatment options as it ensures that clients have the right to make informed decisions about their healthcare. The Patient's Bill of Rights outlines the rights and responsibilities of patients, including the right to receive information about their medical condition, treatment options, risks, and benefits.
The other choices are incorrect because:
A: The Standards of Clinical Practice provide guidelines for healthcare professionals and do not specifically address the client's right to access information.
B: An Advance Health Care Directive is a legal document that specifies a person's wishes regarding medical treatment in the event they are unable to communicate, but it does not necessarily address the right to access treatment information.
D: A Client's Living Will is a legal document that outlines a person's preferences for medical care in certain situations, but it does not specifically address the right to access information about treatment options.