A nurse is having difficulty caring for a client due to variables affecting the communication process.
Which of the following should the nurse identify as an interpersonal variable? - Answers Education
Gender
Perception
A nurse is rehearsing assertive communication approaches to use when declining leadership of a
nursing department committee. Which of the following statements should the nurse make? -
Answers "I decline the opportunity at this time."
This is an assertive form of communication because it contains an "I" statement and it is clear and
firm.
A nurse is caring for a client within the intimate zone of the client's personal space. The nurse should
perform which of the following activities in this space? - Answers Auscultating heart sounds
Changing a dressing
A nurse is filling out an incident report after finding a client lying on the floor. Which of the following
information should the nurse include? - Answers The client was lying on the floor next to his bed.
A nurse is teaching a client about carbon monoxide poisoning. Which of the following statements
should the nurse identify as an indication that the client needs further instruction? - Answers I can
detect the presence of carbon monoxide by a metalic odor.
Carbon monoxide gas is odorless, tasteless, and colorless.
A nurse removes an indwelling urinary catheter that an older adult client has had in place for 2 days.
The nurse should assess the client for which of the following expected outcomes after catheter
removal? - Answers Temporary urinary retention.
Until the bladder regains its full tone, it is common for clients develop urinary retention. If a client
does not urinate for 6 to 8 hr after catheter removal, reinsertion might become necessary.
A nurse is creating a discharge plan. Which of the following nursing statements indicates the nurse
understands when discharge planning should be implemented? - Answers It will begin upon the
clients admission to the facility.
Effective discharge planning must begin upon admission of the client to the facility.
A nurse is orienting a newly licensed nurse about documentation of a client's information in the
electronic health record. Which of the following statements by the newly licensed nurse indicates
understanding of the purpose of documentation? - Answers "Documentation is a communication tool
for the interprofessional health care team."
Documentation provides information to facilitate communication among members of the
interprofessional health care team in making clientycentered decisions, planning appropriate
therapies and evaluating a client's progress.
A nurse in a clinic is teaching a group of clients about preventing low back pain and injury. Which of
the following statements should the nurse identify as an indication that the client requires further
clarification? - Answers "I'll sit with my knees lower than my hips."
To prevent back injuries, the clients should sit with their knees slightly higher than their hips.
A nurse is caring for a client who is postoperative following an appendectomy. The surgeon initially
prescribes a clear liquid diet. Which of the following items should the nurse offer the client? (Select all
that apply.) - Answers Broth
Grape juice
Lemon gelatin
A nurse is implementing direct nursing care for a group of clients in an acute care facility. Which of
the following actions by the nurse is considered an indirect nursing care activity? - Answers Assigning
tasks to an assistive personnel (AP) be assigned to an AP, but the nurse is responsible for verifying
that the tasks have been completed according to standards of care. Delegation of nursing care to an
AP is considered indirect care. (ambulation, bathing and vital signs)