A nurse is caring for a client who is postoperative.

Vital Signs.

0800: Nurses' Notes.

BP 118/72 mm Hg. Heart rate 82/min.

Respiratory rate 16/min.

Temperature 36.7°C (98°F). SaO2 98% on room air.

1000: BP 128/82 mm Hg. Heart rate 94/min.

Respiratory rate 18/min.

Temperature 36.7°C (98°F). SaO2 98% on room air.

Vital Signs.

Nurses' Notes.

0745: Client awake and eating breakfast while watching the news on television.

Client has hearing loss, does not wear a hearing aid, and TV volume is loud.

Rates pain as a 2 on a 0 to 10 pain scale.

Incisional dressing dry and intact.

1000: Nurses' Notes.

Client ambulated in the hallway with a physical therapist.

Client grimacing, appears upset, and is guarding incisional site.

Reports pain as 5 on a 0 to 10 pain scale.

Opioid analgesic administered.

1045: Client resting with eyes closed and listening to music with earphones.

Reports feeling "very sleepy" after pain medication.

Now rates pain as a 3 on a 0 to 10 pain scale.

1300: Ate 75% of lunch.

Several visitors at the bedside.

Which of the following factors could present a barrier to the nurse effectively communicating with the client? Select all that apply.

Client's hearing deficit.

Volume of the client's television.

Numerous visitors in the client's room.

Increase in pain after ambulation.

Adverse effects of opioid analgesic.

Using earphones while listening to music.

Answer and Explanation

Correct Answer : A,B,C,E,F

The correct answers are a. Client's hearing deficit, b. Volume of the client's television, c. Numerous visitors in the client's room, e. Adverse effects of opioid analgesic, and f. Using earphones while listening to music.

Choice A rationale: A client with hearing loss who does not wear a hearing aid may experience difficulty understanding spoken communication, especially in noisy environments, leading to potential miscommunication or misunderstanding.

Choice B rationale: Loud television volume can make it difficult for both the nurse and the client to hear each other, causing interference in their communication and potentially leading to errors in information exchange.

Choice C rationale: The presence of numerous visitors in the room can cause distractions, background noise, and overall interference with the nurse-client communication process, potentially affecting the quality and accuracy of the information exchanged.

Choice E rationale: Opioid analgesics can cause adverse effects such as drowsiness, confusion, or cognitive impairment, hindering effective communication between the nurse and the client, as the client's ability to comprehend, retain, and convey information may be impaired.

Choice F rationale: The use of earphones while listening to music can impair the client's ability to hear the nurse, creating a barrier to effective communication. This could potentially lead to missed or misunderstood information and, consequently, affect the quality of care.

Choice D rationale (Incorrect choice): While an increase in pain after ambulation could affect the client's mood, cooperation, and ability to engage in effective communication, it does not directly create a barrier to the nurse's ability to communicate with the client. Pain management is an essential aspect of postoperative care, and effective communication can actually facilitate pain assessment, management, and overall client well-being.

Nursing Test Bank

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Naxlex Comprehensive Predictor Exams

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Free Nursing Study Resources

Correct Answer is ["A","B","E","F"]

Explanation

Choice A rationale:
Givingtheclientprintedinformationisaneducationalmethodthatinvolvesreadingandcomprehension,whicharekeycomponentsofthecognitivedomain.
Choice B rationale:
Teaching about expected reference ranges and target blood glucose levels is based on the cognitive domain of learning. This involves understanding and comprehending information, which is a key aspect of cognitive learning. It's important for a client with diabetes to know what their blood glucose levels should be and what values to aim for to manage their condition effectively.
Choice C rationale:
Asking the client how they feel about checking their blood glucose levels is related to the affective domain of learning. It focuses on the client's emotions and attitudes rather than cognitive understanding, which is not directly mentioned in the question.
Choice D rationale:
Asking the client to demonstrate checking their blood glucose level is based on the psychomotor domain of learning. This involves physical skills and actions, which are not explicitly mentioned in the question.
Choice E rationale:
Giving the client a fill-in-the-blank quiz is also based on the cognitive domain of learning. Quizzes and assessments are tools that help assess a client's understanding and retention of information, which aligns with cognitive learning.
Choice F rationale:
Asking the client to describe the manifestations of hypoglycemia and hyperglycemia is also based on the cognitive domain of learning. It requires the client to recall and explain information, which is a cognitive process.

A. "The use of social media is not included in the COE.”. B. "Professional expectations are included in the COE.”. C. "Student nurses are not held accountable to COE.”. D. "Criteria for obtaining licensure is included in the COE.”. .

Correct Answer is B

Explanation

Choice A rationale:

"The use of social media is not included in the COE.”. This statement is not accurate. The use of social media is addressed in the Code of Ethics (COE) for nurses. The COE provides guidance on how nurses should maintain professional boundaries and ethical behavior in the digital age, which includes considerations for social media use.

Choice B rationale:

"Professional expectations are included in the COE.”. This statement is correct. The Code of Ethics (COE) for nurses outlines the professional expectations and standards that nurses are expected to adhere to. It provides guidance on ethical conduct, accountability, and the responsibilities of nurses in their practice.

Choice C rationale:

"Student nurses are not held accountable to COE.”. This statement is not accurate. Student nurses are expected to adhere to the same ethical standards outlined in the Code of Ethics (COE) as registered nurses. While there may be some variations in practice expectations based on the level of training, ethical principles apply to all nurses, including student nurses.

Choice D rationale:

"Criteria for obtaining licensure is included in the COE.”. This statement is not accurate. The Code of Ethics (COE) primarily focuses on ethical principles, professional behavior, and the responsibilities of nurses in their practice. It does not typically include criteria for obtaining licensure, as licensure requirements are determined by licensing boards and regulatory bodies.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is creating a teaching plan for a client who has a new diagnosis of diabetes mellitus. Exhibits Which of the following teaching methods is based on the cognitive domain of learning? Select all that apply.

Correct Answer is ["A","B","E","F"]

Explanation

A nurse is preparing an in-service to review the Code of Ethics (COE) with a group of nursing colleagues.Which of the following statements should the nurse make during the in-service about the COE?

Correct Answer is B

Explanation

A nurse is teaching a class on ethical principles.The nurse should include that protecting a client's safety by not causing harm refers to which of the following ethical principles?

A nurse is teaching a class about Piaget's stages of cognitive development.The nurse should instruct that abstract thinking develops during which of the following stages?

A nurse is preparing an in-service about communication for a group of staff nurses.Which of the following information should the nurse include when discussing the electronic mode of communication?

A nurse is caring for a client who is at the end of life.Which of the following interventions is most effective in reducing the client's social isolation?

A nurse is preparing to administer cefadroxil oral suspension 15 mg/kg PO to a client who weighs 98 lb. Available is cefadroxil 250 mg/5 mL. Which of the following actions should the nurse take first?

A nurse in an emergency department is performing triage on a group of clients. Which of the following clients should the nurse see first?

A nurse is instructing a client who has heart disease about ways to improve their health such as eating a heart-healthy diet.Which of the following concepts is the nurse demonstrating to the client?

A nurse is documenting client care including only unexpected findings related to the client's condition.Which of the following documentation methods is the nurse utilizing?