A nurse manager is providing staff education about working with patients who have a history of anger and aggression.
Which of the following information should the nurse include in the teaching?
Stand directly in front of the patient when talking.
Know the layout of the facility.
Bring security with you for all patient interactions.
Provide immediate verbal feedback for escalating behavior.
Avoid wearing necklaces during patient care.
Correct Answer : B,D,E
Choice A rationale
Standing directly in front of a patient who has a history of anger and aggression can be perceived as threatening and may escalate the situation.
Choice B rationale
Knowing the layout of the facility can help the nurse to plan for safe exits or to put barriers between themselves and the patient if needed.
Choice C rationale
Bringing security for all patient interactions can escalate the situation and should only be done if there is a clear threat to safety.
Choice D rationale
Providing immediate verbal feedback for escalating behavior can help to de-escalate the situation and reassure the patient.
Choice E rationale
Avoiding wearing necklaces during patient care can reduce the risk of injury to the nurse.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Lower quadrant pain is a common symptom of many conditions, including ectopic pregnancy. However, it does not specifically indicate the presence of blood in the peritoneum.
Choice B rationale
Cullen’s sign, which is the appearance of bruising in the skin around the umbilicus, is a sign of blood in the peritoneum. It can occur in conditions such as a ruptured ectopic pregnancy.
Choice C rationale
Goodell’s sign is a softening of the cervix that typically occurs early in pregnancy. It does not indicate the presence of blood in the peritoneum.
Choice D rationale
Chadwick’s sign is a bluish discoloration of the cervix, vagina, and labia that occurs in early pregnancy. It does not indicate the presence of blood in the peritoneum.
Correct Answer is A
Explanation
Choice A rationale
The priority action for a nurse when caring for a patient exhibiting symptoms of a myocardial infarction is to initiate oxygen therapy. Oxygen therapy is crucial because it increases the amount of oxygen in the blood, which can help reduce the heart’s workload and relieve pain. This intervention is aimed at reducing myocardial oxygen demand and improving oxygen supply to the ischemic myocardium.
Choice B rationale
Obtaining a blood sample is important as it can help diagnose a myocardial infarction. Blood tests can measure levels of certain proteins, such as troponins, in the bloodstream that can indicate heart muscle damage. However, this is not the immediate priority when compared to initiating oxygen therapy.
Choice C rationale
Attaching the leads for a 12-lead ECG is an important step in the assessment of a patient with suspected myocardial infarction. An ECG can show whether the heart muscle has been damaged and where the damage has occurred. However, this should be done after initiating oxygen therapy.
Choice D rationale
Inserting an IV catheter is a necessary step in the management of a myocardial infarction. It allows for the administration of medications and fluids as needed. However, it is not the first priority. The first priority is to stabilize the patient, which includes initiating oxygen therapy.
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