ANSWERS /SURE PASS A+
1.Mr. Matthew tells the nurse that he has never been hospitalized. He appears anxious
and frequently turns to his wife for reassurance. What is the best response by the
nurse?
A. "Is there anything you would like to ask your healthcare provider?"
B. "What concerns do you have about being hospitalized."
C. "We give good care to all our clients in the hospital."
D. "Your healthcare provider the chosen the best hospital in the city.": B. "What
concerns do you have about being hospitalized?"
Rationale: This response utilizes principles of therapeutic
communication. It is an open-ended question designed to allow Mr.
Matthew to verbalize any concerns about hospitalization that might be
contributing to his anxiety.
,2.Mr. Matthew tells the nurse, "My sweetheart and I have never been apart during our
55-year marriage." What action should the nurse implement to help reduce Mr.
Matthew's anxiety during the admission process?
A. Explain the room environment to Mr. and Mrs. Matthew.
B. Ask Mrs. Matthew if she would like to rest in the waiting room.
C. Ask Mr. Matthew if he would like a prescription for an antianxiety medica- tion.
D. Reassure Mr. and Mrs. Matthew that everything will be okay.: A. Explain the
room environment to Mr. and Mrs. Matthew.
Rationale: This action will reduce the client's anxiety by including the
spouse and orientating them both to the room.
3.Mr. Matthew states the pain level in his right foot is 8 on a scale of 1-10. He says he
has been favoring his foot by staying in bed the past week. In planning his care, which
nursing diagnosis should take priority?
A. Risk for caregiver role strain.
B. Risk for social isolation.
C. Impaired physical mobility.
, D. Imbalanced nutrition: more than body requirements.: C. Impaired physical
mobility.
Rationale: Mr. Matthew's limited activities support this nursing
diagnosis. Improving mobility is a nursing priority to prevent the many
potential complications.