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What is the purpose of a contract between a nurse and a client?
- A. Contracts specify the participation and responsibilities of both parties.
- B. Contracts indicate the feeling tone established between participants.
- C. Contracts are legally binding and prevent either party from ending the relationship prematurely.
- D. Contracts define the roles the participants take.
Correct Answer: A
Rationale: The purpose of a contract between a nurse and a client is to specify the participation and responsibilities of both parties. It outlines the expectations, contributions, and duties of each party involved in the professional relationship. This ensures clarity and mutual understanding. Choice B is incorrect as contracts do not indicate feeling tone but rather focus on the professional aspects. Choice C is incorrect because while contracts are legally binding, their primary purpose is not to prevent premature termination but to establish guidelines. Choice D is incorrect as contracts focus more on responsibilities and participation rather than specific roles.
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A 50-milliliter (ml) bolus of normal saline fluid is ordered by the physician. The physician wants it to infuse in 30 minutes. The nurse should set the pump rate at:
- A. 100 ml per hour for one hour.
- B. 60 ml per hour for one-half hour
- C. 120 ml per hour for one hour.
- D. 50 ml per hour for one hour.
Correct Answer: A
Rationale: To infuse a 50 ml bolus in 30 minutes, the rate should be calculated as follows: 50 ml / 30 min = 100 ml per hour. Therefore, the correct answer is to set the pump rate at 100 ml per hour for one hour. Choice A is the correct rate based on the calculation. Choices B, C, and D all provide incorrect rates that do not match the physician's order. Choice B would only deliver 30 ml in 30 minutes, not the ordered 50 ml. Choice C would deliver 120 ml in one hour, which is 20 ml more than ordered. Choice D would only provide 25 ml over 30 minutes, not the full 50 ml prescribed.
A twenty-one-year-old man suffered a concussion, and the MD ordered an MRI. The patient asks, 'Will they allow me to sit up during the MRI?' The correct response by the nurse should be:
- A. "I will have to talk to the doctor about letting you sit upright during the test."?
- B. "You will be positioned in the reverse Trendelenburg position to maximize the view of the brain."?
- C. "The radiologist will let you know."?
- D. "You will have to lie down on your back during the test."?
Correct Answer: D
Rationale: The correct answer is to inform the patient that they will have to lie down on their back during the MRI. This positioning is necessary for the scan to obtain accurate images of the brain. Choice A is incorrect because the decision on the positioning during the MRI is typically determined by the imaging protocol and not subject to negotiation during the test. Choice B is incorrect as the reverse Trendelenburg position is not commonly used during MRI scans. Choice C is incorrect because the radiologist does not usually make decisions on patient positioning during the MRI; it is predetermined by the imaging requirements.
While admitting a client to an acute-care psychiatric unit, the nurse asks about substance abuse based on:
- A. psychiatric disorders' higher prevalence in addicted populations
- B. individuals with psychiatric disorders' increased susceptibility to substance abuse
- C. the importance of detecting and diagnosing substance disorders in acute-care psychiatric settings
- D. the significant impact of undetected substance problems on the treatment of psychiatric disorders
Correct Answer: B
Rationale: The correct answer is 'individuals with psychiatric disorders' increased susceptibility to substance abuse.' It is crucial to inquire about substance abuse during admission to an acute-care psychiatric unit because individuals with psychiatric disorders are more prone to experiencing substance abuse issues. Addressing substance abuse is vital for effective treatment and to prevent relapse in psychiatric disorders. Option A is incorrect as it focuses on the prevalence of psychiatric illness in addicted populations rather than the relationship between psychiatric disorders and substance abuse. Option C is incorrect as it exaggerates the ease of detecting and diagnosing substance disorders in acute-care psychiatric settings. Option D is incorrect as undetected substance problems can indeed significantly impact the treatment of psychiatric disorders, but the main reason for inquiring about substance abuse is the increased susceptibility of individuals with psychiatric disorders to such issues.
Which information obtained from the mother of a child with cerebral palsy most likely correlates to the diagnosis?
- A. She was born at 42 weeks gestation.
- B. She had meningitis when she was 6 months old.
- C. She had physiologic jaundice after delivery.
- D. She has frequent sore throats.
Correct Answer: B
Rationale: The diagnosis of meningitis at age 6 months correlates to a diagnosis of cerebral palsy. Cerebral palsy, a neurological disorder, is often associated with birth trauma or infections of the brain or spinal column. Answers A, C, and D are not related to the question. Gestational length (choice A) is not a direct risk factor for cerebral palsy. Physiologic jaundice (choice C) and frequent sore throats (choice D) are not typically associated with cerebral palsy.
When supporting a family who has just experienced a sudden and unexpected death, the nurse needs to know:
- A. that survivors have greater emotional turmoil and shock than when death is expected.
- B. that survivors have less emotional turmoil and shock than when death is expected.
- C. that survivors have the same emotional turmoil and shock as when death is expected.
- D. that survivors have little emotional turmoil and shock because they were not there.
Correct Answer: A
Rationale: The correct answer is that survivors have greater emotional turmoil and shock than when death is expected. Sudden death produces more emotional turmoil and shock in survivors compared to gradual, expected death. Survivors of sudden death do not have the opportunity to engage in anticipatory grief. The unexpectedness of sudden death is the most disturbing and unbalancing factor, leading to heightened emotional turmoil and shock. Choice B is incorrect as survivors of sudden death experience more emotional turmoil and shock. Choice C is incorrect because sudden death brings about a different level of emotional turmoil and shock. Choice D is incorrect as survivors of sudden and unexpected death still go through significant emotional distress.