A nurse is assessing a 6-year-old child who has experienced violence at school. Which of the following strategies should the nurse use during their assessment of this client

Assess the child without their caregiver present.

Have toys or drawing materials available for the child.

Focus on the physical domain of health.

Have the child carefully repeat the events of the trauma.

Answer and Explanation

The Correct Answer is B

Providing toys or drawing materials can help the child express their thoughts, feelings, and experiences in a nonverbal and developmentally appropriate manner. Play-based activities allow children to communicate and process their emotions more comfortably than verbal communication alone.

A. For young children, especially those who have experienced trauma, the presence of a caregiver can provide comfort, reassurance, and support during the assessment process.

C. Neglecting the child's emotional needs can result in overlooking important aspects of their experience and hinder their recovery.

D. Asking the child to repeat the events of the trauma can be retraumatizing and overwhelming for them.

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Correct Answer is C

Explanation

Nausea refers to the sensation of feeling sick to the stomach, and it is a symptom that is reported by the client. Since it is based on the client's perception and cannot be directly observed by the nurse, it is considered subjective data.

A. Blood pressure is a measurable vital sign that can be obtained using a blood pressure cuff and stethoscope.

B. Cyanosis is a bluish discoloration of the skin or mucous membranes due to insufficient oxygenation of the blood.

D. Petechiae are small, pinpoint-sized red or purple spots on the skin that result from bleeding under the skin.

A. To decrease the client's stress B. To detect changes in the client's condition C. To empower the client to be engaged in personal care D. To Increase the client's motivation to learn about their culture

Correct Answer is C

Explanation

Understanding a client's cultural and spiritual beliefs can indeed empower them to be engaged in their personal care. By incorporating their beliefs into the care plan, the client may feel more respected, understood, and motivated to participate in their treatment.

A. Familiarity with cultural and spiritual beliefs allows the nurse to provide care that aligns with the client's values and practices, potentially reducing anxiety or distress but is not directly related to schizophrenia

B. While knowledge of cultural and spiritual beliefs is important for holistic care, it may not directly aid in the detection of changes in the client's condition related to schizophrenia.

D. While exploring a client's cultural and spiritual beliefs may spark interest in learning more about their culture, this may not necessarily be the primary purpose for collecting this information in the context of caring for someone with schizophrenia.

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A nurse is assessing a 6-year-old child who has experienced violence at school. Which of the following strategies should the nurse use during their assessment of this client

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is completing a client's history and physical examination. Which of the following information should the nurse consider subjective data?

Correct Answer is C

Explanation

A nurse is asking a client who has schizophrenia about their cultural and spiritual beliefs. Which of the following is the purpose for collecting this information?

Correct Answer is C

Explanation

A nurse is caring for a client who is well-hydrated and who demonstrates no evidence of anemia. Which of the following laboratory values gives the nurse an assessment of the adequacy of the client's protein uptake and synthesis?

A 35-year-old woman has been admitted to the hospital for a hysterectomy secondary to uterine cancer caused by smoking, and the nurse is collecting subjective data prior to surgery. Which statements by the nurse could be construed as non-judgmental? (Select All that Apply.)

A nurse is caring for a client with an allergic skin condition. The client develops wheezing, a swollen tongue, and hives. Which of the following is the nursing priority?

A nurse is preparing to collect health history data during a client's admission. Which of the following questions should the nurse use to promote this discussion?

During an assessment, the nurse determines that a client sees more than one primary care provider and has obtained prescriptions from each provider. Which method would be most appropriate to determine a client's current medication regimen?

A nurse is providing care to a client who asks, "What is the meaning of holistic nursing care?" The nurse should give which of the following responses?

A nurse manager in a community clinic is explaining the concept of culture to a newly licensed nurse. Which of the following statements should the nurse manager use to describe a subculture?