Nursing Elites

1. While interviewing a client, the nurse takes notes to assist with accurate documentation later. Which statement is most accurate regarding note-taking during an interview?

• A. The client’s comfort level is increased when the nurse maintains eye contact while taking notes.
• B. The interview process is enhanced with note-taking, allowing the client to speak at a normal pace.
• C. Note-taking during an interview is not a legal obligation of the examining nurse.
• D. The nurse’s ability to directly observe the client’s nonverbal communication is limited with note-taking.

Correct answer: D

Rationale: During an interview, note-taking can hinder the nurse’s ability to directly observe the client's nonverbal cues such as body language, facial expressions, and tone of voice. These nonverbal cues are crucial for understanding the client's emotions, feelings, and overall communication. Therefore, it is essential for the nurse to strike a balance between note-taking for documentation purposes and actively observing the client's nonverbal communication to ensure a comprehensive assessment. Choices A, B, and C are incorrect because maintaining eye contact, enhancing the interview process with note-taking, and legal obligations of note-taking during an interview do not directly address the issue of limited observation of nonverbal communication while taking notes.

2. What principle about patient-nurse communication should guide a nurse's fear of 'saying the wrong thing' to a patient?

• A. Patients tend to appreciate a well-meaning person who conveys genuine acceptance, respect, and concern for their situation.
• B. The patient is more interested in talking to you than listening to what you have to say and is not likely to be offended.
• C. Considering the patient's history, there is little chance that the comment will do any actual harm.
• D. Most people with a mental illness have by necessity developed a high tolerance for forgiveness.

Correct answer: A

Rationale: The correct principle guiding nurse-patient communication is that patients value genuine acceptance, respect, and concern. Choice A is the correct answer because showing genuine care and concern for the patient's situation fosters a positive and therapeutic relationship. Choice B is incorrect as effective communication involves active listening and responding appropriately, not assuming the patient is only interested in talking. Choice C is incorrect because a patient's history does not guarantee immunity to harm from inappropriate comments. Choice D is incorrect as it generalizes individuals with mental illness and forgiveness, which is not directly related to communication fears.

3. A male veteran who recently returned from a war zone has post-traumatic stress disorder (PTSD) and is admitted to the psychiatric ward due to admitted suicidal ideation. On admission, the client’s family informed the healthcare provider that therapy sessions did not seem to be helping. Select only one intervention that has the highest priority.

• A. Administer paroxetine 40 mg as prescribed.
• B. Develop a list of therapy programs.
• C. Remove all shaving equipment.
• D. Determine if the client has a suicide plan.

Correct answer: C

Rationale: The highest priority intervention in this scenario is to ensure the safety of the client who is admitted due to suicidal ideation. Removing all shaving equipment is crucial to prevent self-harm or suicide attempts using sharp objects. Administering medication or developing a list of therapy programs can be important but ensuring immediate safety takes precedence. Determining if the client has a suicide plan is also essential but not as urgent as removing potential means for self-harm.

4. The healthcare professional is developing a discharge plan for a client recovering from alcohol withdrawal. Which instruction should be included in the client’s discharge teaching?

• A. Avoid all social situations involving alcohol.
• B. Continue taking prescribed medications.
• C. Contact a support group such as Alcoholics Anonymous.
• D. Avoid using any over-the-counter medications.

Correct answer: C

Rationale: It is essential to include instructions for the client to contact a support group like Alcoholics Anonymous in their discharge teaching. Support groups play a vital role in providing ongoing support, guidance, and encouragement during the recovery process from alcohol withdrawal, helping to prevent relapse. Choice A is incorrect because avoiding all social situations involving alcohol may not be practical or sustainable in the long term. Choice B is important but is not specific to the client's alcohol recovery needs. Choice D is not the top priority compared to the importance of connecting with a support group for ongoing assistance and accountability.

5. During an annual physical at the corporate clinic, a male employee expresses to the RN that his high-stress job is causing trouble in his personal life. He mentions getting so angry while driving to and from work that he has considered 'getting even' with other drivers. How should the RN respond?

• A. “Anger is contagious and could lead to major confrontations.”
• B. “Try not to let your anger cause you to act impulsively.”
• C. “Expressing your anger to a stranger could lead to an unsafe situation.”
• D. “It seems like there are many situations that make you feel angry.”

Correct answer: B

Rationale: The correct response for the RN is to advise the employee not to act impulsively when feeling angry. This approach helps the individual learn to manage anger in a constructive manner, reducing the likelihood of potential conflicts. Choice A is incorrect because although acknowledging that anger can escalate into confrontations is valid, it does not provide immediate guidance on managing the anger. Choice C focuses on the dangers of expressing anger to strangers but does not address the core issue of managing anger. Choice D simply acknowledges the employee's feelings without providing guidance on how to address the situation effectively.

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