Nokea
Which behaviors indicate the nurse is using criticalthinking standards when communicating with patients? (Select all that apply.)
- A. Instills faith
- B. Uses humility
- C. Portrays self-confidence
- D. Exhibits supportiveness
Correct Answer: B
Rationale: The correct answer is B: Uses humility. Critical thinking in nursing involves being open-minded, self-aware, and willing to consider different perspectives. Humility allows nurses to acknowledge their limitations, seek feedback, and continuously learn and improve. Instilling faith (A) may be important but does not directly relate to critical thinking standards. Self-confidence (C) can be beneficial, but excessive confidence can lead to closed-mindedness. Supportiveness (D) is valuable in patient care but does not specifically demonstrate critical thinking standards. In summary, humility enables nurses to approach patient communication with an open and reflective mindset, essential for applying critical thinking standards effectively.
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When administering a patients eye drops, the nurse recognizes the need to prevent absorption by the nasolacrimal duct. How can the nurse best achieve this goal?
- A. Ensure that the patient is well hydrated at all times.
- B. Encourage self-administration of eye drops.
- C. Occlude the puncta after applying the medication.
- D. Position the patient supine before administering eye drops.
Correct Answer: C
Rationale: The correct answer is C: Occlude the puncta after applying the medication. By occluding the puncta after applying the eye drops, the nurse can prevent the medication from draining into the nasolacrimal duct and being absorbed systemically. This is important to ensure that the medication remains in the eye and exerts its intended local effect.
Choice A (Ensure that the patient is well hydrated at all times) is incorrect because hydration status does not directly prevent absorption through the nasolacrimal duct.
Choice B (Encourage self-administration of eye drops) is incorrect as the method of administration does not prevent absorption through the nasolacrimal duct.
Choice D (Position the patient supine before administering eye drops) is incorrect as it does not address the specific issue of preventing absorption through the nasolacrimal duct.
A patient with HIV infection has begun experiencing severe diarrhea. What is the most appropriate nursing intervention to help alleviate the diarrhea?
- A. Administer antidiarrheal medications on a scheduled basis, as ordered.
- B. Encourage the patient to eat three balanced meals and a snack at bedtime.
- C. Increase the patients oral fluid intake.
- D. Encourage the patient to increase his or her activity level.
Correct Answer: C
Rationale: The correct answer is C: Increase the patient's oral fluid intake. This is because severe diarrhea can lead to dehydration, which can be dangerous for patients with HIV infection. By increasing oral fluid intake, the patient can stay hydrated and prevent further complications. Administering antidiarrheal medications on a scheduled basis (Choice A) may provide temporary relief but does not address the underlying issue of dehydration. Encouraging the patient to eat balanced meals (Choice B) and increase activity level (Choice D) may be important for overall health but do not directly address the immediate concern of dehydration caused by severe diarrhea.
The nurse is caring for a patient who is scheduled for a cervical discectomy the following day. During health education, the patient should be made aware of what potential complications?
- A. Vertebral fracture
- B. Hematoma at the surgical site
- C. Scoliosis
- D. Renal trauma
Correct Answer: B
Rationale: The correct answer is B: Hematoma at the surgical site. This is a potential complication of cervical discectomy due to the risk of bleeding post-surgery. Hematoma can compress nearby structures and lead to increased pain and swelling.
A: Vertebral fracture is not a typical complication of cervical discectomy, as the surgery aims to relieve pressure on the spinal cord caused by a herniated disc, not to cause fractures.
C: Scoliosis is a condition characterized by abnormal lateral curvature of the spine, and it is not directly related to cervical discectomy.
D: Renal trauma is not a common complication of cervical discectomy, as the surgery focuses on the cervical spine and does not involve the kidneys or renal system.
A nurse is assessing the patient’s meaning ofillness. Which area of focus by the nurse ispriority?
- A. On the way a patient reacts to disease
- B. On the malfunctioning of biological processes
- C. On the malfunctioning of psychological processes
- D. On the way a patient reacts to family/social interactions
Correct Answer: A
Rationale: The correct answer is A because understanding how a patient perceives and reacts to their illness is crucial for providing holistic care. By focusing on the patient's perspective, the nurse can address their emotional, mental, and social needs. Choice B is incorrect as it only considers biological aspects. Choice C is incorrect as it only focuses on psychological processes. Choice D is incorrect as it does not directly address the patient's perspective on illness. A holistic approach that considers the patient's meaning of illness is essential for providing patient-centered care.
The patient is having lower abdominal surgeryand the nurse inserts an indwelling catheter. What is the rationale for the nurse’s action?
- A. The patient may void uncontrollably during the procedure.
- B. Local trauma sometimes promotes excessive urine incontinence.
- C. Anesthetics can decrease bladder contractility and cause urinary retention.
- D. The patient will not interrupt the procedure by asking to go to the bathroom.
Correct Answer: C
Rationale: The correct answer is C because anesthetics used during surgery can decrease bladder contractility, leading to urinary retention. By inserting an indwelling catheter, the nurse ensures proper drainage of urine and prevents bladder distention. This helps to maintain the patient's comfort and prevent complications such as urinary retention and potential bladder injury.
Choice A is incorrect because inserting a catheter is not primarily to prevent uncontrollable voiding during surgery. Choice B is incorrect as local trauma does not promote excessive urine incontinence necessitating catheterization. Choice D is incorrect because the primary purpose of catheter insertion is not to prevent interruption of the procedure by bathroom breaks.