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Why is it important for a nurse to possess an appropriate degree of assertiveness?
- A. Reduces interpersonal stress.
- B. Builds effective team relationships.
- C. Supports development of technical nursing skills.
- D. Reduces potential for the increased risk of client injury.
- E. Supports the delivery of effective, appropriate nursing care.
Correct Answer: A,B,D,E
Rationale: Assertiveness is one of the most important skills for nurses in the workplace to reduce their interpersonal stress, build effective team relationships, and to provide sufficient nursing care. A nurse's ability to be assertive is key not only to preventing medical errors but also to reducing patients' risk and improving nursing care.
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An adolescent asks a nurse conducting an assessment interview, 'Why should I tell you anything? You'll just tell my parents whatever you find out.' What is the nurse's best reply regarding patient confidentiality?
- A. That is not true. What you tell us is private and held in strict confidence. Your parents have no right to know.
- B. Yes, your parents may find out what you say, but it is important that they know about your problems.
- C. What you say about feelings is private, but some things, like suicidal thinking, must be reported to the treatment team.
- D. It sounds as though you are not really ready to work on your problems and make changes.
Correct Answer: C
Rationale: The patient has a right to know that most information will be held in confidence but that certain material must be reported or shared with the treatment team, such as threats of suicide, homicide, use of illegal drugs, or issues of abuse.
Which entry in the medical record best meets the requirement for problem-oriented charting?
- A. A: Pacing and muttering to self. P: Sensory perceptual alteration, related to internal auditory stimulation. I: Given fluphenazine 2.5 mg at 0900 and went to room to lie down. E: Calmer by 0930. Returned to lounge to watch TV.
- B. S: States, 'I feel like I'm ready to blow up.' O: Pacing hall, mumbling to self. A: Auditory hallucinations. P: Offer haloperidol 2 mg. I: haloperidol 2 mg at 0900 . E: Returned to lounge at 0930 and quietly watched TV.
- C. Agitated behavior. D: Patient muttering to self as though answering an unseen person. A: Given haloperidol 2 mg and went to room to lie down. E: Patient calmer. Returned to lounge to watch TV.
- D. Pacing hall and muttering to self as though answering an unseen person. haloperidol 2 mg administered at 0900 with calming effect in 30 minutes. Stated, 'I'm no longer bothered by the voices.'
Correct Answer: B
Rationale: Problem-oriented documentation uses the first letter of key words to organize data: S for subjective data, O for objective data, A for assessment, P for plan, I for intervention, and E for evaluation.
A nurse assessing a new patient asks, 'What is meant by the saying, 'You can't judge a book by looking at the cover'?' Which aspect of cognition is the nurse assessing?
- A. Mood
- B. Attention
- C. Orientation
- D. Abstraction
Correct Answer: D
Rationale: Patient interpretation of proverbial statements gives assessment information regarding the patient's ability to abstract, which is an aspect of cognition.
Before assessing a new patient, a nurse is told by another health care worker, 'I know that patient. No matter how hard we work, there isn't much improvement by the time of discharge.' What action will the nurse take to provide appropriate care for this patient?
- A. Document the other worker's assessment of the patient.
- B. Assess the patient based on data collected from all sources.
- C. Validate the worker's impression by contacting the patient's significant other.
- D. Discuss the worker's impression with the patient during the assessment interview.
Correct Answer: B
Rationale: Assessment should include data obtained from both the primary and reliable secondary sources. Biased assessments by others should be evaluated as objectively as possible by the nurse, keeping in mind the possible effects of countertransference.
Select the best outcome for a patient with this nursing diagnosis: impaired social interaction, related to sociocultural dissonance as evidenced by stating, 'Although I'd like to, I don't join in because I don't speak the language very well.' What should the focus of an appropriate outcome be?
- A. Demonstrating improved social skills
- B. Expressing a desire to interact with others
- C. Becoming more independent in decision making
- D. Selecting and participating in one group activity per day
Correct Answer: D
Rationale: The outcome describes social involvement on the part of the patient. Neither cooperation nor independence has been an issue. The patient has already expressed a desire to interact with others. Outcomes must be measurable.