practice Guide
1.A nurse educator is presenting information about the nursing
process to a class of nursing students. What definition of the nursing
process should be included in the presentation?
1. Procedures used to implement client care
2. Sequence of steps used to meet the client’s needs
3. Activities employed to identify a client’s problem
4. Mechanisms applied to determine nursing goals for the client
2.A nurse on the medical-surgical unit tells other staff members, “That
client can just wait for the lorazepam; I get so annoyed when people drink
too much.” What does this nurse’s comment reflect?
1. Demonstration of a personal bias
2. Problem solving based on assessment
3. Development of client acuity to set priorities
4. Consideration of the complexity of client care
3.A teenager begins to cry when talking with the nurse about the
problem of not being able to make friends. What is the most
therapeutic nursing intervention? TC
1. Sitting quietly with the client
2. Telling the client that crying is not helpful
3. Suggesting that the client play a board game
4. Recommending how the client can change this situation
4.After being medicated for anxiety, a client says to a nurse, “I guess you
are too busy to stay with me.” How should the nurse respond? TC
1. “I’m so sorry, but I have to see other clients”
, 2. “I have to go now, but I will come back in 10 minutes” ( offering self)
3. “You’ll be able to rest after the medicine starts working”
4. “You’ll feel better after I’ve made you more comfortable”
5.A physician is admitted to the psychiatric unit of a community hospital. The
client, who was restless, loud, aggressive, and resistive during the admission
procedure, states, “I will take my own blood pressure.” What is the nurse’s most
therapeutic response? TC
1. “Right now you are just another client”
2. “If you would rather, I’m sure you will do it correctly”
3. “I will get the attendants to assist me if you do not cooperate”
4. “I am sorry, but I cannot allow that because I must take your blood
pressure”(boundaries