Review Questions
1
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What is the primary rationale for a nursing assessment of a client’s nonverbal communication?
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Nonverbal communication gives clues to what the client is feeling without words.
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Nonverbal communication will not explain the verbal communication.
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The client has garbled speech and looks to the family member to help.
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The nurse should assess the verbalizations first, then look at the nonverbal actions.
2
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What main purpose does self-reflection provide for the nurse?
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a guide for professional behavior with clients
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a guide to encourage the client to disclose their feelings
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helps the nurse-client relationship be open to improvement and change
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helps the nurse take action on the client’s behaviors
3
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What is an example of an action by the nurse that demonstrates active listening?
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The nurse is facing the client and then looks to the family for answers.
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The nurse is leaned back in the chair, arms crossed, asking questions.
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The nurse is asking questions and looking at their watch frequently.
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The nurse is looking at the client, nodding to answers.
4
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A newly licensed nurse shares with their preceptor, “I really like working with Gloria! She and I are so much alike!” What concept should the preceptor review with the nurse?
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legal implications of nursing practice
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aspects of a social relationship
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documentation issues for mental health
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aspects of physical boundaries
5
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The nurse is preparing to assess the client’s attitude toward mental illness. Rank these steps in priority order for effectiveness of the interaction.
- The nurse offers educational resources.
- The nurse examines their own beliefs.
- The nurse plans to use open-ended questions during the interaction.
- The nurse explores the client’s cultural values without judgment.
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1,2,3,4
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2,1,3,4
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4,2,1,3
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2,3,4,1
6
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What statement by a client demonstrates their need for support?
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“I will attend group therapy each week because I know it helps me.”
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“I plan to keep my appointments with the nurse to review my weekly treatment plan.”
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“I don’t like to take medications; however, I know it helps me stay balanced in my thinking.”
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“This medication I am taking causes so many side effects, I don’t know if I can keep taking it.”
7
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What is an example of a nurse’s most therapeutic response when a client’s statement demonstrates a barrier to seeking treatment?
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Client: “My coworkers joke about mental illness, but I don’t join in.”
Nurse: “Good for you! They shouldn’t make fun of that.” -
Client: “I explained my medication side effects to my little brother and he says he understands now.”
Nurse: “Isn’t he only ten years old?” -
Client: “My father thinks I should handle my problems myself and stop spending money on doctor visits.”
Nurse: “How do you feel about your father’s comment?” -
Client: “I schedule my group therapy for after work.”
Nurse: “The time you go doesn’t make any difference.”
8
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The nurse is planning discharge teaching and notes the client’s previous lack of compliance with follow-up care. What is a contributing factor that the client cannot control?
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the client’s attitude
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limited access to health care
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discussions with the nurse
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becoming informed about medications
9
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What is an example of the nurse implementing the Clinical Judgment Measurement Model?
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recognizing cues and prioritizing needs
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forming solutions based on the nurse’s prior experience
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taking all action immediately
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taking all action at a later time
10
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Why would the nurse continually observe the behavior of the client during both the physical exam and the psychosocial assessment?
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to see if the behavior matches the verbal communication and if the client is cooperative
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to determine if the client is listening to the nurse and if the client’s responses are truthful
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to detect the client’s sexual identity
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to evaluate the outcomes of care
11
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What is the best nursing response when the client says, “I will answer that question if you promise not to tell anyone”?
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“You will be closely watched while you are here.”
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“You can trust me; I won’t tell anyone.”
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“Information is only shared with the health-care team.”
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“Of course, I have to tell what you say.”
12
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What is the best nursing inquiry to assess spirituality/cultural data on the psychosocial nursing assessment?
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“What are your favorite hobbies?”
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“Are you a member of a faith community?”
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“What sports do you enjoy?”
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“How far did you go in school?”