NUR 1211C Chapter Notes - Chapter 1: Dsm-5, Nursing Diagnosis, Motor Coordination

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1. Which statement regarding nursing interventions should a nurse identify as accurate?
a. Nursing interventions occur independently but in concert with overall treatment team goals.
i. Rationale: The nurse should understand that nursing interventions occur independently but
in conjunction with overall treatment goals.
2. A client diagnosed with vascular neurocognitive disorder (NCD) is discharged to home under the care of his
wife. Which information should cause the nurse to question the client's safety?
a. The client smokes one pack of cigarettes per day.
i. Rationale: The nurse should question the client's safety at home if the client smokes
cigarettes. Patients with this disorder become confused and are at risk for injury,
3. What should be the nurse's primary goal during the preinteraction phase of the nurse-client relationship?
a. To explore self-perceptions.
i. Rationale: The priority nursing action during the preinteraction phase of the nurse-client
relationship should be to examine one's feelings, fears, and anxieties about working with a
particular client. All individuals bring attitudes and feelings from prior experiences so the
nurse needs to be aware how these preconceptions may affect their ability to care for
individual clients.
4. What is a nurse's purpose in providing appropriate feedback?
a. To give the client critical information.
i. Rationale: Feedback should be descriptive, specific, and directed toward a behavior that the
person has the capacity to modify and should impart information rather than offer advice.
5. The nurse is interviewing a newly admitted psychiatric client. Which is an example of offering a "general
a. "Yes, I see. Go on."
i. Rationale: The nurses' statement, "Yes, I see. Go on," is an example of a general lead.
Offering general leads encourages the client to continue sharing information.
6. A client diagnosed with Neurocognitive Disorder (NCD) is ataxic, disoriented and wanders. Which is the
priority nursing diagnosis?
a. Risk for trauma
i. Rationale: The priority nursing diagnosis for this client is risk for injury. The client who is
ataxic suffers from motor coordination deficits and is at an increased risk for falls. Clients
that wander are also at higher risk for injury.
7. A student nurse asks an instructor how best to develop nursing outcomes for clients. Which response by
the instructor most accurately answers the student's question?
a. "With client collaboration, outcomes should be based on client problems."
i. Rationale: Client outcomes are most realistic and achievable when there is collaboration
among the interdisciplinary team members, the client, and significant others.
8. A nurse states to a client, "Things will look better tomorrow after a good night's sleep." This is an example
of which communication technique?
a. The non-therapeutic technique of 'giving false reassurance.'
i. Rationale: False reassurance indicates to the client that there is no cause for anxiety,
thereby devaluing the client's feelings and may discourage them from further expression of
their feelings.
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