Question 1

Carla is a 13-year-old girl who has just been diagnosed with diabetes mellitus type 1. Before discharge, the nurse conducts a teaching session that mainly focuses on blood sugarcontrol. As a nurse educator, the nurse makes use of which of the following methods of instruction when teaching Carla about diabetes care?
A)Interactive computer software that discusses diabetes mellitus type 1 management
B)A book that discusses diabetes care; the book is written by a celebrity with diabetes type 1
C)Group discussion that focuses on diabetes management; the group consists of teen-agers with diabetes type 1
D)A pamphlet that contains steps and tips on how to manage diabetes mellitus type 2

Accepted Answer

An interactive software program is the most effective method of instruction for adolescents. Before conducting a teaching session, it is essential to select a method of instruction that will most effectively educate the client. As an educator, the nurse should recognize that the choice of instruction is dependent on the client's familiarity with the method. Keeping up to date with technology is vital to getting the attention of adolescents. Teenagers learn best when they interact with the information shared.

Question 2

A nurse is working with Marieta, a Hispanic immigrant who speaks little English. Marieta is referred to thenurse to discuss reproductive health. Which of the following interventions by the nurse is the least therapeutic when working with the client?
A)Provide education materials written in Spanish.
B)Provide a language interpreter.
C)Include a Hispanic member of the health care team in the teaching session.
D)Use conversational pacing during the teaching session.

Accepted Answer

Using conversational pacing is the least therapeutic and appropriate technique of communication. Although this technique facilitates trust and decreases anxiety, it is the least therapeutic when working with a client who knows little English. The nurse may provide education materials written in Spanish or ask a language interpreter to facilitate therapeutic communication. Including a Hispanic member of the health care team may also facilitate the client in meeting her needs.

Question 3

Which specific communication technique should a nurse utilize when caring for a client with mild cognitive decline due to Alzheimer's disease?
A)Keep communication simple and concrete.
B)Offerthe client alternative ideas.
C)Implement comic enjoyment of the imperfect.
D)Use open-ended questions.

Accepted Answer

The nurse should keep communication simple and concrete. Offering alternative ideas, using humor, and using open-ended questions do not facilitate therapeutic communication when working with a client who has cognitive decline. Other useful therapeutic communication techniques when working with this client include maintaining eye contact and allowing time for the client's responses.

Question 4

Andie is a registered nurse who works in a medical-surgical unit. Andie understands the importance of avoiding barriers to achieve therapeutic nurse-client communication during the course of care. Which of the following techniques is NOT a barrier to therapeutic communication?
A)Giving advice
B)Using probing questions
C)Using open-ended questions
D)Using leading questions

Accepted Answer

Using open-ended questions is not a barrier to therapeutic communication. This technique indicates acceptance by the nurse and emphasizes the value of the client's initiative. Giving advice inhibits client decision-making. Using probing questions may cause client resentment. Using leading questions causes the client to provide answers that will please the nurse.

Question 5

A therapeutic nurse-client interaction has three phases: introduction, working, and termination. Which of the following interventions is appropriately employed during the working phase?
A)Reviewing the client's progress
B)Establishing each person's role in the relationship
C)Making a contract with the client regarding goals of the interaction
D)Implementation of a care plan through therapeutic alliance

Accepted Answer

Implementation of a care plan through therapeutic alliance is employed during the working phase. Reviewing the client's progress is implemented during the termination phase. Establishing each person's role in the interaction and making a contract regarding goals are implemented during the introduction phase.

Question 6

A nurse understands that trust builders are essential when establishing a therapeutic nurse-client relationship. When communicating with an anxious elderly client who is visually impaired, which of the following trust builders is the most appropriate?
A)Communicate in an organized and professional manner.
B)Use touch in a gentle matter when speaking to the client.
C)Offeropen and frank communication without prejudice.
D)Offer all available resources to the client.

Accepted Answer

Using touch in a gentle manner while speakingto the client is the most appropriate technique when communicating with an anxious client who is visually impaired. This trust-builder is termed personal space. The other options may facilitate a therapeutic nurse-client relationship, but they are not the most appropriate for the client. Communicating in an organized and professional manner facilitates trust and respect. Offering open and frank communication without prejudice facilitates respect and open communication. Offering all available resources to the client promotes honesty.

Question 7

A nurse is assisting Brenda, a female client who has difficulty controlling self-destructive behaviors. The nurse utilizes a contractmade with the client as an intervention. Which of the following is the most important purpose for the use of contracts as a behavioral management technique?
A)It is used to give a client greater control over negative thinking.
B)It promotes self-expression and exchange of ideas.
C)It is used hold the client accountable for her actions.
D)It is used to give the client a sense of security.

Accepted Answer

A contract made with the client holds the client accountable for her actions. This is also used as a constant reminder of client tasks. Cognitive restructuring gives the client greater control over negative thinking. Group therapy promotes self-expression. Setting and enforcing limits give a client a sense of security.

Question 8

A nurse is tasked with making the room assignments in a psychiatric unit. The nurse makes the room assignments based on all of the following factors EXCEPT:
A)The client's length of stay
B)The client's race
C)The client's level of personal distress
D)The client's overall behavior

Accepted Answer

The client's race is not one of the factors considered when making room assignments. Room assignments on a psychiatric unit are based on numerous factors. In addition to length of stay, level of personal distress, and overall behavior, gender, fragility and age are also considered.

Question 9

Eunice is a 15-year-old female who sustained lacerated wounds on the lower extremities. Which evaluation would be most indicative of readiness to begin selfwound care?
A)The client watches as the nurse performs care.
B)The client begins to ask questions about how the wound is managed.
C)The client turns away every time the nurse cares for the wound.
D)The client is reading a pamphlet on wound management.

Accepted Answer

When the client begins to ask questions about how the wound is managed, it is an indication to begin self wound care. Asking questions demonstrates a readiness to learn. If the client is not willing to see the wound, it is an indication that she is not ready for wound care. Watching the nurse perform wound care and reading a pamphlet represents an interest but they are a passive activity.

Question 10

A nurse prepares to teach a newly diagnosed diabetic client about diabetes and how it is managed. Which of the following is the initial step when preparing the client for a teaching session?
A)Gather written and visual materials for the client's use.
B)Evaluate the client's willingness to learn.
C)Identify the client's level of education.
D)Determine what the client knows about the disease.

Accepted Answer

The initial step is to determine what the client knows about the disease. The other options are also considered when planning a teaching session, but it is a priority to determine the client's current knowledge. It is important to begin where the client is to determine areas of strength and to clarify misconceptions about the disease.

Question 11

A nurse is caring for a 7-year-old boy who has an IQ score of 70. The child's mother asks the nurse about the optimal learning environment for child. Which of the following is the best response of the nurse?
A)"Your son is educable. He may be mainstreamed for some classes as he receives additional help for other subjects."
B)"Your son is educationally trainable, but he will require supervision throughout life."
C)"Your sound will most likely require lifelong support and supervision."
D)"Your son will need custodial care. Educational skills will aim for basic skills of eating and use of extremities."

Accepted Answer

A child with an IQ of 70 is educable, and he may be mainstreamed for some classes as he receives additional help for other subjects. A child who ranges on the IQ scale from 35 to 50 is educationally trainable. A child who has an IQ of 20 to 35 is most likely to require lifelong support and supervision. A child with an IQ of less than 20 will most likely need custodial care with educational goals focusing on basic skills.

Question 12

Circe is a 58-year-old housewife who had a surgery for permanent colostomy seven days ago. She is extremely concerned about caring for her colostomy. The client refuses to do the draining and cleaning herself. As the nurse changes the bag, Mrs. Circe said, "Does it really look that red and swollen?" Before discharge, the nurse must include this activity to promote self-care of colostomy:
A)Provide step-by-step written instruction with illustrations on colostomy care.
B)Teach Mrs. Circe's daughter how to perform proper colostomy care.
C)Discuss what the client should expect during colostomy care.
D)Allow the client to perform some portion of colostomy care.

Accepted Answer

In order to promote self-care of colostomy, the nurse should discuss what should be expected during colostomy care which includes the correct appearance of the stoma. It is clear from Mrs. Circe's statement that she lacks knowledge of what a stoma should look like, making her reluctant to do the draining and cleaning herself. Providing step-by-step instructions with illustrationsare appropriate only if the client is comfortable in carrying out the whole procedure. Being able to perform portions of the task, and teaching other people to do the procedure do not facilitate independence.

Question 13

Dane is a 34-year-old lawyer who will have a total hip replacement surgery in two weeks. He is concerned about allowable sexual activity after hip replacement. Mr. Dane asks the nurse what is a safe sexual activity after surgery. The nurse makes which of the following appropriate statements?
A)"You must have a talk about sexual activity after hip replacement with your surgeon."
B)"Usually, sexual activity is allowed 10 weeks after surgery."
C)"There are basically no restrictions on sexual positions so long as you don't experience pain."
D)"Are you concerned about your surgery affecting your sex life?"

Accepted Answer

The most appropriate statement of the nurse should focus on assessing the client's view on how his surgery could affect his sex life. The nurse must help allay fears about injury or dislocation of hips when having sexual intercourse. There is no single sex position that will prevent discomfort. The nurse must help the client understand other ways of expressing intimacy between couples. Option A does not immediately address the client's needs. Option B is incorrect; sexual intercourse may be safe four to six weeks after surgery to allow healing of wound and muscles. Option C is incorrect; initially the client is not allowed to perform activities that involve extreme flexion of the hips or twisting of the legs and heavy lifting. Pain and discomfort are expected during the first few months after the surgery.

Question 14

Dee, a female client who has a history of major depression, is rushed to the emergency department after attempting to jump off from a building. The client says she has been planning to kill herself since her husband left her for another woman. Which action by the admitting nurse is the priority?
A)Search the client for weapons.
B)Pad the side rails of the bed.
C)Place the client in a room with CCTV camera.
D)Remove the client's clothing and search her belongings.

Accepted Answer

The priority action of the nurse is to place the client in a room with a CCTV camera. This intervention allows the nursing staff to monitor the client at all times. The client's clothing will be searched for a weapon upon removal, but the search is performed by a security staff. Padding the side rails is more appropriate for a client with seizures. The client's clothing will be removed, but it has to be done in a private area with a CCTV camera.

Question 15

Wilkins is an 85-year-old female diagnosed with an advanced case of Alzheimer's disease. The client's memory has severely declined through the years. As the nurse assists the client in performing morning care, the client tells the nurse that she worked as a neuroscientist in the 1950s. The client's husband immediately corrects the client by informing the nurse that his wife worked as science teacher. After the morning care, the nurse talks to the husband in private and encourages him to do which of the following?
A)Leave the area as soon as his wife starts telling her stories.
B)Continue correcting her wife's stories.
C)Allow his wife to tell her storiesas she recalls them.
D)Discourage his wife from telling inconsistent stories.

Accepted Answer

The nurse encourages the husband to allow his wife to tell her stories, as she recalls them. Clients with Alzheimer's disease mask their loss of memory by spending more time talking about their past. If the husband continuously and repeatedly tries to correct the stories, this may increase the client's agitation and may affect her self-esteem. Leaving the area or discouraging his wife from telling stories may further isolate the client from the rest of the world.

Question 16

Belle, a mother of two children, informs the nurse that her three-year-old potty trained son has started urinating in his pants. The regression started about two months after she gave birth to her daughter. Which response by the nurse is the most therapeutic?
A)"Initiate a time out before it becomes a pattern."
B)"Talk to your son about the change. Spend an hour with him, without your daughter, every other day to let him feel that he is still important."
C)"It is an expected occurrence. Children usually regress when a new baby is introduced to the family. Encourage the child to go the rest room every time he feels the need to urinate."
D)"It is an expected outcome. Do not worry. It is normal."

Accepted Answer

The nurse should encourage the mother to talk to her son about the change and to spend more time alone with the child to let him know that he is still important. A time-out does not address the client's concerns. Regression is an expected response to a new family member, but encouraging the child to go to rest room does not facilitate the goal of letting the child feel that he is still important. When a nurse tells a mother not to worry about it, this response belittles the client's concerns.

Question 17

A competent adult client, a member of the Jehovah's Witnesses, refuses blood transfusion. The nurse caring for the client follows his decision based on which ethical principle?
A)Advance directive
B)The right to refuse treatment
C)The right to refuse third-party interference
D)Substituted judgment

Accepted Answer

The right to refuse treatment is based on the ethical principle of respect of autonomy of an individual. A client can refuse the treatment as long as he or she is mentally competent and informed about the risks associated with the refusal of the treatment.

Question 18

A client who is in for coronary artery bypass gastric surgery expresses his fears to the nurse about the surgery. Which of the following statements by the nurse is appropriate?
A)"Don't be afraid. The surgeon is one of the best in this facility."
B)"It's normal to feel nervous. Every patient feels that way before surgery."
C)"Would you like to tell me what you were told about the surgery?"
D)"I'll explain every important detail about the procedure."

Accepted Answer

Asking the client to share the information he has been given can stimulate further discussion between the nurse and the client. The nurse has to know what the client knows in order to provide clarifications and individualized explanations of care, resulting in reduced anxiety levels. Options A and B belittle the client's concerns, and option D can cause more anxiety.

Question 19

A nurse observes an agitated client pacing up and down the hallway. Which of the following statements by the nurse is the most appropriate?
A)"If you don't stop now, you're leaving us with no other choice but to restrain you until you calm down."
B)"You will be placed in seclusion until you calm down."
C)"What is causing your agitation?"
D)"You can join the group activity in the dayroom."

Accepted Answer

Asking the client what is causing the agitation is a way for the client to become more aware of his behavior. Options A and B are threatening remarks. Option D is not appropriate at this time.

Question 20

A female client with depression tells the nurse that her family is better off without her. The nurse's most appropriate response is:
A)"You will feel better once the therapeutic effects of your medications set in."
B)"Everyone feels this way sometimes."
C)"Have you talked to your family about this?"
D)"Are you planning to hurt yourself?"

Accepted Answer

Depressed clients are at risk for suicide. The nurse must assess suicidal ideation and must directly ask the client if there is a plan for self-harm.

Quiz 2: Partnership

A nurse is working with Marieta, a Hispanic immigrant who speaks little English. Marieta is referred to thenurse to discuss reproductive health. Which of the following interventions by the nurse is the least therapeutic when working with the client?

Which specific communication technique should a nurse utilize when caring for a client with mild cognitive decline due to Alzheimer's disease?

Andie is a registered nurse who works in a medical-surgical unit. Andie understands the importance of avoiding barriers to achieve therapeutic nurse-client communication during the course of care. Which of the following techniques is NOT a barrier to therapeutic communication?

A therapeutic nurse-client interaction has three phases: introduction, working, and termination. Which of the following interventions is appropriately employed during the working phase?

A nurse understands that trust builders are essential when establishing a therapeutic nurse-client relationship. When communicating with an anxious elderly client who is visually impaired, which of the following trust builders is the most appropriate?

A nurse is assisting Brenda, a female client who has difficulty controlling self-destructive behaviors. The nurse utilizes a contractmade with the client as an intervention. Which of the following is the most important purpose for the use of contracts as a behavioral management technique?

A nurse is tasked with making the room assignments in a psychiatric unit. The nurse makes the room assignments based on all of the following factors EXCEPT:

Eunice is a 15-year-old female who sustained lacerated wounds on the lower extremities. Which evaluation would be most indicative of readiness to begin selfwound care?

A nurse prepares to teach a newly diagnosed diabetic client about diabetes and how it is managed. Which of the following is the initial step when preparing the client for a teaching session?

A nurse is caring for a 7-year-old boy who has an IQ score of 70. The child's mother asks the nurse about the optimal learning environment for child. Which of the following is the best response of the nurse?

Dane is a 34-year-old lawyer who will have a total hip replacement surgery in two weeks. He is concerned about allowable sexual activity after hip replacement. Mr. Dane asks the nurse what is a safe sexual activity after surgery. The nurse makes which of the following appropriate statements?

Dee, a female client who has a history of major depression, is rushed to the emergency department after attempting to jump off from a building. The client says she has been planning to kill herself since her husband left her for another woman. Which action by the admitting nurse is the priority?

Belle, a mother of two children, informs the nurse that her three-year-old potty trained son has started urinating in his pants. The regression started about two months after she gave birth to her daughter. Which response by the nurse is the most therapeutic?

A competent adult client, a member of the Jehovah's Witnesses, refuses blood transfusion. The nurse caring for the client follows his decision based on which ethical principle?

A client who is in for coronary artery bypass gastric surgery expresses his fears to the nurse about the surgery. Which of the following statements by the nurse is appropriate?

A nurse observes an agitated client pacing up and down the hallway. Which of the following statements by the nurse is the most appropriate?

A female client with depression tells the nurse that her family is better off without her. The nurse's most appropriate response is: