Although the client denies pain, the Practical Nurse (PN) observes the client is breathing rapidly with clenched fists and is grimacing. The PN’s best response to his observations would be: * Select one answer

“Where do you hurt?”

"I am glad you are feeling beter and have no discomfort.”

"What you are saying and what I am observing don’t seem to match.”

"It makes me uncomfortable when you are not honest with me.”

Answer and Explanation

The Correct Answer is C

Choice A reason: “Where do you hurt?” is not the best response to the PN’s observations. This response shows closed-ended questioning, which is a communication technique that involves asking questions that require a yes or no answer or a specific piece of information. It also shows confrontation, which is a communication technique that involves challenging or opposing the other person’s statements or behaviors. It may make the client feel defensive, pressured, or misunderstood, and may discourage further communication. Therefore, this choice is incorrect.

Choice B reason: "I am glad you are feeling beter and have no discomfort.” is not the best response to the PN’s observations. This response shows false reassurance, which is a communication technique that involves minimizing or dismissing the other person’s feelings or situation. It also shows inconsistency, which is a communication barrier that involves giving contradictory or conﬂicting messages. It may make the client feel confused, ignored, or invalidated, and may undermine the trust or rapport between the client and the PN. Therefore, this choice is incorrect.

Choice C reason: "What you are saying and what I am observing don’t seem to match.” is the best response to the PN’s observations. This response shows reﬂection, which is a communication technique that involves restating or paraphrasing what the client has said to show understanding and clarify meaning. It also shows congruence, which is a communication skill that involves using consistent verbal and nonverbal cues to reinforce the message and avoid confusion or misunderstanding. It helps the client to recognize and explore their own feelings or thoughts, and shows that the PN is atentive, respectful, and empathetic. Therefore, this choice is correct.

Choice D reason: "It makes me uncomfortable when you are not honest with me.” is not the best response to the PN’s observations. This response shows self-disclosure, which is a communication technique that involves sharing personal information or feelings with the other person. It also shows accusation, which is a communication barrier that involves blaming or criticizing the other person for their statements or behaviors. It may make the client feel

guilty, ashamed, or angry, and may damage the relationship or communication between the client and the PN. Therefore, this choice is incorrect.

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Correct Answer is ["A","C","D"]

Explanation

Choice A reason: This is correct because it is an approved nursing diagnosis that describes a lack of cognitive information related to a specific topic.

Choice B reason: This is incorrect because it is not an approved nursing diagnosis, but rather a data or assessment finding that describes the condition of the client’s pupils.

Choice C reason: This is correct because it is an approved nursing diagnosis that describes an unpleasant sensory and emotional experience associated with actual or potential tissue damage.

Choice D reason: This is correct because it is an approved nursing diagnosis that describes a decrease in oxygenation and/or elimination of carbon dioxide at the alveolar-capillary membrane.

Choice E reason: This is incorrect because it is not an approved nursing diagnosis, but rather a medical diagnosis that describes a malignant neoplasm of any body part.

Choice F reason: This is incorrect because it is not an approved nursing diagnosis, but rather a medical diagnosis that describes a dysfunction of the kidneys.

A. Speak slowly and provide brief and simple examples B. Give very complete, detailed explanations of all information C. Get an interpreter or family member to interpret for the nurse as needed D. Speak quickly and avoid eye contact, which could be perceived as threatening

Correct Answer is A

Explanation

Choice A reason: This is correct because it shows that the nurse is respectful and sensitive to the client’s language and cultural needs. Speaking slowly and providing examples can help the client comprehend and retain the information.

Choice B reason: This is incorrect because it shows that the nurse is overwhelming and insensitive to the client’s language and cultural needs. Giving too much information or using complex terms can confuse and frustrate the client.

Choice C reason: This is incorrect because it shows that the nurse is assuming and delegating the responsibility of communication to someone else. Getting an interpreter or a family member may not be necessary or appropriate if the client speaks English. The nurse should communicate directly with the client as much as possible.

Choice D reason: This is incorrect because it shows that the nurse is rude and disrespectful to the client’s language and cultural needs. Speaking quickly and avoiding eye contact can make the client feel ignored or intimidated. The nurse should maintain eye contact and speak at a normal pace.

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Although the client denies pain, the Practical Nurse (PN) observes the client is breathing rapidly with clenched fists and is grimacing. The PN’s best response to his observations would be: * Select one answer

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is ["A","C","D"]

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Correct Answer is A

Explanation

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