Nokea
Which patient would most likely be uncomfortable with close personal space during an interaction with the nurse?
- A. A 19-year-old white female patient who is standing 2 feet in front of the nurse.
- B. A 40-year-old African-American male patient who is sitting next to the nurse.
- C. A 60-year-old Latin-American female patient who is seated across from the nurse.
- D. An 82-year-old patient from France who is lying in bed with the nurse sitting next to the bed.
Correct Answer: A
Rationale: The correct answer is A because cultural background and individual preferences influence personal space comfort. In this case, the 19-year-old white female patient standing only 2 feet away may feel uncomfortable with close personal space. Different cultures and age groups have varying norms regarding personal space. The other choices are less likely to be uncomfortable based on cultural norms and distance from the nurse. The 40-year-old African-American male patient sitting next to the nurse, the 60-year-old Latin-American female patient seated across, and the 82-year-old patient from France lying in bed with the nurse sitting next to them are all at a comfortable distance, thus less likely to be uncomfortable with personal space.
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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.
The nursing staff are making suggestions about how to help Ms. C (bowel resection) overcome her reluctance to perform colostomy care. Which suggestion will the team leader try first?
- A. Verbally reexplain the procedure and give her written material.
- B. Have a family member come in and do it for her.
- C. Continue to do it for her until she is ready.
- D. Ask her to hold the clamp while the bag is being emptied.
Correct Answer: A
Rationale: The correct answer is A because it involves providing Ms. C with information and resources to help her understand and feel more comfortable with the colostomy care procedure. Verbally reexplaining the procedure and providing written material will empower her with knowledge and autonomy. Choice B undermines her independence and may not address her reluctance. Choice C promotes dependency rather than encouraging her to take ownership of her care. Choice D involves a hands-on approach that may not address her underlying concerns or fears about the procedure. Overall, choice A is the most appropriate initial step to support Ms. C in overcoming her reluctance.
The nurse cares for a patient with urinary incontinence after a stroke. Which response by the nurse is best?
- A. "You seem upset about this. We can work together on a bladder retraining program."
- B. "I don't mind cleaning up your mess. I am used to it because my child does this at night."
- C. "Don't be embarrassed. A lot of patients have this problem after a stroke."
- D. "I will bring you some diapers to wear instead of having you wet the bed all the time."
Correct Answer: A
Rationale: The correct answer is A because it demonstrates empathy, collaboration, and a patient-centered approach. By acknowledging the patient's feelings and offering to work together on a solution, the nurse shows respect and support. This response promotes patient dignity and autonomy.
Choice B is incorrect as it is unprofessional and may be perceived as insensitive. Choice C, while acknowledging the commonality of the issue, lacks a proactive approach to address the problem. Choice D does not promote independence or address the patient's emotional needs.
A nurse manager offers a staff nurse a choice between working 8- or 12-hour shifts. Which statement, if made by the staff nurse, is nonassertive and may result in a frustrated response from the nurse manager?
- A. "I want to decide the shifts for all of the other staff nurses."
- B. "Do whatever you want. It doesn't really matter to me."
- C. "Thank you for offering me a choice. I prefer 12-hour shifts."
- D. "You will never be able to give me what I really want to work."
Correct Answer: A
Rationale: The correct answer is A because it shows an attempt to control others' decisions, which is nonassertive and inappropriate in a professional setting. Assertiveness involves expressing one's own needs and preferences while respecting others' choices. Option A implies a desire for power over others' schedules, leading to potential conflict and frustration. In contrast, options B and D show indifference and negativity, respectively, without clearly stating preferences. Option C is assertive and appreciative of the choice offered, clearly stating a preference for 12-hour shifts without imposing on others.
The charge nurse informs a staff nurse that it is her turn to float to another unit. Which response by the staff nurse is aggressive?
- A. "I had such a bad experience last time. Please send another nurse instead of me."
- B. "I will miss working with you today, but I understand that it is my turn to float."
- C. "I will not survive on the other unit. The staff are always too busy to help me."
- D. "I will float, but you'll be sorry. You cannot handle emergencies without me."
Correct Answer: C
Rationale: The correct answer is C because the response is aggressive and defensive. The staff nurse is making a negative and exaggerated statement about not surviving on the other unit, implying that others are incompetent and not willing to help. This response lacks professionalism and teamwork, showing an unwillingness to adapt and collaborate.
Choice A is not aggressive as it expresses a personal negative experience and suggests sending another nurse. Choice B is not aggressive as it acknowledges the situation and shows understanding. Choice D is assertive but not necessarily aggressive; it implies importance but does not attack or undermine others.