It is taught that when parents are informed that their child has been born with a abnormality they respond with a grief reaction. The first step in the
... [Show More] normal grief reaction is:
A) Acceptance
B) shock-denial
C) withdrawal
D) planning - correct answer B) Shock-denial
On entering a client's room during change-of-shift rounds, you notice that the client and spouse have their backs turned to each other, and both have their arms folded across their chests. Which of the following is the best action for you to take at this time?
A) Introduce yourself and begin discharge teaching.
B) Proceed with the tasks you were intending to perform.
C) Say nothing and leave quickly, closing the door behind you.
D) Ask the client and spouse if they need some time alone right now. - correct answer D) Ask the client and spouse if they need some time alone right now.
Response Feedback:
The situation suggests that you entered during a stressful time. Offering privacy would be appropriate. Because the situation indicates tension between the couple, this is not the time to initiate teaching.
Before performing a procedure for the first time at a new agency, what does the travel nurse do?
A) Refuses to perform the procedure
B) Asks the charge nurse how to perform the procedure
C) Reads about the procedure in the policy and procedure manual
D) Performs the procedure as at the agency where the nurse previously worked - correct answer C) Reads about the procedure in the policy and procedure manual
Response Feedback:
Every agency has its own policies and way of performing procedures. The charge nurse may not know how the procedure should be performed or may explain it incorrectly. The procedure may be performed differently than in the previous agency. If the nurse refuses to perform procedures that are covered by the nursing practice act, the nurse could be fired.
The surgical unit has initiated the use of a pain rating scale to assess the severity of clients' pain during their postoperative recovery. The nurse assigned to a client can look at the pain flow sheet to see the client's pain scores over the last 24 hours. Use of the pain scale is an example of adherence to which intellectual standard?
A) Depth
B) Specificity
C) Relevance
D) Consistency - correct answer D) Consistency
Response Feedback:
Using the same pain scale for all clients and ratings promotes consistency—each nurse has the same measurement scale to compare assessments. Relevance refers to how applicable the assessment is. An assessment has depth when it deals with less obvious issues. Specificity refers to the ability of the assessment to provide information about the particular problem of interest.
Which of the following is the most accurate information to give a nurse during change-of-shift reporting?
A) Client refuses to take medications.
B) Client reports sharp pain in left anterior knee.
C) Client encouraged to consume more fluids
D) Client expressed concern about pending surgery. - correct answer B) Client reports sharp pain in left anterior knee. [Show Less]