Nokea
Which of the following is a positive interpretation of body language?
- A. Clenched jaw
- B. Tilt of head
- C. Arms crossed
- D. Rubbing nose
Correct Answer: B
Rationale: An example of a positive interpretation of body language is the tilt of the head. Negative examples of body language include a clenched jaw, crossed arms, and rubbing the nose.
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Which of the following is a reason why silence is considered therapeutic?
- A. It demonstrates concern or affection.
- B. It communicates caring and support.
- C. It encourages a client's verbal communication.
- D. It is therapeutic when a client is uncomfortable.
Correct Answer: C
Rationale: Silence is the art of remaining quiet. One of its therapeutic uses is to encourage a client's verbal communication. Affective touch is typically used to demonstrate concern or affection. Its intention is to communicate caring and support. The nurse uses affective touch therapeutically in many situations, including when a client is uncomfortable.
The nurse is caring for a client who has been diagnosed with a cerebral vascular accident and displays expressive aphasia. In which manner does the nurse best promote communication?
- A. Ask the client open-ended questions and allow time for a response.
- B. Give the client a tablet and pencil to use.
- C. Provide the client with a speaking valve.
- D. Use a picture board with common responses.
Correct Answer: D
Rationale: For clients with aphasia, it is most helpful to have a picture board with responses to convey meaning. This decreases some frustration and allows the client to have some control over care. Asking a client with expressive aphasia open-ended questions is not the best option because the client is unable to give lengthy responses. Depending on the client's degree of aphasia, closed-ended questions may be appropriate. A speaking valve is useful for a client who has a tracheostomy or one who has had laryngectomy.
Which of the following means of comprehending new information best describes a cognitive learner?
- A. The learner learns through information that appeals to feelings.
- B. The learner likes to learn by doing
- C. The learner learns by combining three styles of learning
- D. The learner processes information by listening to facts
Correct Answer: D
Rationale: The cognitive learner processes information best by listening to or reading facts and descriptions. The affective learner is more attuned to learning when presented with information that appeals to feelings. The psychomotor learner typically likes to learn by doing. A combination of the three styles tends to optimize learning, although most people favor one style of learning.
The charge nurse delegates the administration of a pain medication to a practical nurse. Which statement, made by the charge nurse, indicates that the final step in the delegation process has been completed?
- A. Did you document the administration of the pain medication on the medication record?
- B. Is the physician aware of the client's need for pain medication?
- C. What is the client's pain level since administering the pain medication 30 minutes ago?
- D. Have you ever administered this type of pain medication previously?
Correct Answer: C
Rationale: The final step in the delegation process is to ensure that the task has been completed and determine the resulting outcome of the action. In this case, it is ensuring the medication is given and assessing for pain relief. The other steps may be completed in the delegation process, but they are not completed last.
Which of the following nurse statements is completed in the working phase of the nurse-client relationship?
- A. Tell me about your religious beliefs during this season of the year.
- B. I will put a chair in the bathroom so you can begin personal care. I will return to assist you as needed.
- C. I understand that you are feeling anxious about going home. Let me assess you before we talk.
- D. Let's talk about a way to assist you to a standing position so you can walk in the hall.
Correct Answer: B
Rationale: During the working phase of the nurse-client relationship, the nurse and the client puts the mutually developed plan into action. Each person shares in performing the task that leads to the desired outcome, which supports the client's independence. In the introductory phase, the nurse should be gathering information regarding religious beliefs. In the terminating phase, the client may feel apprehensive about assuming independent activity or self-care. Developing the plan with activities such as assisting to a standing position to walk in the hall is completed in the introductory phase.