Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
A nurse begins to bathe a newly admitted client who reports that they have not had anything to eat that day. The nurse interrupts the bath and obtains a healthy meal for the client. This action by the nurse is an example of which of the following?
A. Promoting trust
Promoting trust. Trust is essential for establishing a therapeutic relationship with the client and facilitating their recovery. The nurse demonstrates trustworthiness by responding to the client's needs in a timely and respectful manner, and by providing them with a healthy meal that meets their nutritional requirements.
B. Countertransference
C. Boundary crossing
D. Veracity
This question is an excerpt from Nurse Dive's nursing test bank - ATI Comprehensive Predictor 2023 Proctored Exam. Take the full exam now
Full Explanation
The correct answer is A. Promoting trust. Trust is essential for establishing a therapeutic relationship with the client and facilitating their recovery. The nurse demonstrates trustworthiness by responding to the client's needs in a timely and respectful manner, and by providing them with a healthy meal that meets their nutritional requirements.
Similar Questions
A nurse is reinforcing discharge teaching with the caregiver of a client who has dependent personality disorder. Which of the following instructions should the nurse include in theteaching?
A. Limit the client's social interactions.
B. Encourage the client to be assertive
Encourage the client to be assertive. A dependent personality disorder is characterized by excessive reliance on others for emotional and practical support, fear of abandonment, difficulty expressing disagreement, and low self-esteem. The nurse should instruct the caregiver to help the client develop autonomy and self-confidence by encouraging them to express their opinions, make their own choices, and take responsibility for their actions.
C. Assume responsibility for making the client's decisions
None
D. Maintain a verbal no-harm contract with the client
None
Full Explanation
The correct answer is B. Encourage the client to be assertive. Dependent personality disorder is characterized by excessive reliance on others for emotional and practical support, fear of abandonment, difficulty expressing disagreement, and low self-esteem. The nurse should instruct the caregiver to help the client develop autonomy and self-confidence by encouraging them to express their opinions, make their own choices, and take responsibility for their actions.
A nurse is obtaining informed consent from a client who is scheduled for an invasive procedure. The client states, "I don't understand why this procedure is necessary." Which of the following actions should the nurse take?
A. Ask the client to sign the consent form anyway.
This would violate the patient's right to autonomy and self-determination
B. Notify the charge nurse about the situation.
Informed consent is when a healthcare provider explains a medical treatment to a patient before the patient agrees to it. The patient has the right to know their state of health, the diagnosis, and the treatments available, and to choose any alternative. The nurse is responsible for obtaining consent when initiating care, and reviewing consent before providing the care ordered by another health care professional. If the patient does not understand why the procedure is necessary, the nurse should notify the charge nurse or the physician who ordered the procedure, so that they can provide more information and answer any questions
C. Remind the client about the specifics of the procedure.
These are not within the nurse's scope of practice and may be considered as giving medical advice.
D. Explain to the client that the procedure will help treat his diagnosis
These are not within the nurse's scope of practice and may be considered as giving medical advice.
Full Explanation
The correct answer is B. Notify the charge nurse about the situation. Informed consent is when a healthcare provider explains a medical treatment to a patient before the patient agrees to it. The patient has the right to know their state of health, the diagnosis, and the treatments available, and to choose any alternative. The nurse is responsible for obtaining consent when initiating care, and reviewing consent before providing the care ordered by another health care professional. If the patient does not understand why the procedure is necessary, the nurse should notify the charge nurse or the physician who ordered the procedure, so that they can provide more information and answer any questions.
The nurse should not ask the client to sign the consent form anyway (A), as this would violate the patient's right to autonomy and self-determination.
The nurse should not remind the client about the specifics of the procedure (C) or explain to the client that the procedure will help treat his diagnosis (D), as these are not within the nurse's scope of practice and may be considered as giving medical advice.
A nurse is collecting data from a 4-month-old infant at a well-child visit. For which of the following findings should the nurse notify the provider?
A. Anterior fontanel closed
Anterior fontanel closed. The anterior fontanel is one of two soft spots on an infant's skull that allow for brain growth and development. The anterior fontanel normally closes between 9 and 18 months of age. If it closes earlier than expected, it may indicate a condition called craniosynostosis, which is when the skull bones fuse prematurely and restrict brain growth. This can lead to increased intracranial pressure, developmental delays, and abnormal head shape. Therefore, if a nurse observes that a 4-month-old infant has a closed anterior fontanel, they should notify the provider for further evaluation. The other options are normal developmental milestones for a 4-month-old infant and do not require notification of the provider.
B. Plays with toes
C. Posterior fontanel closed
D. Moves objects to mouth
Full Explanation
The correct answer is A. Anterior fontanel closed. The anterior fontanel is one of two soft spots on an infant's skull that allow for brain growth and development. The anterior fontanel normally closes between 9 and 18 months of age. If it closes earlier than expected, it may indicate a condition called craniosynostosis, which is when the skull bones fuse prematurely and restrict brain growth. This can lead to increased intracranial pressure, developmental delays, and abnormal head shape. Therefore, if a nurse observes that a 4-month-old infant has a closed anterior fontanel, they should notify the provider for further evaluation. The other options are normal developmental milestones for a 4-month-old
infant and do not require notification of the provider.