During a therapy session, a client begins to cry while discussing a traumatic experience. What is the nurse’s most appropriate response?

“I can see this is very difficult for you.”.

“Please don’t cry, it’s not good for you.”.

“Why are you crying?”

“Let’s move on to a different topic to distract you.”.

Answer and Explanation

The Correct Answer is A

Choice A rationale
“I can see this is very difficult for you.”. This response is appropriate as it acknowledges the client’s emotions and provides validation. It demonstrates empathy and encourages the client to express their feelings, which is essential in therapeutic communication.
Choice B rationale
“Please don’t cry, it’s not good for you.”. This response is inappropriate as it dismisses the client’s emotions and may make them feel invalidated. Crying is a natural response to emotional distress, and the nurse should support the client in expressing their feelings.
Choice C rationale
“Why are you crying?” This response is also inappropriate as it may come across as judgmental or dismissive. It does not provide the support and empathy the client needs during a difficult moment.
Choice D rationale
“Let’s move on to a different topic to distract you.”. This response is not appropriate as it avoids addressing the client’s emotions and may make the client feel that their feelings are not important. The nurse should focus on supporting the client through their emotional experience.

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Correct Answer is C

Explanation

Choice A rationale
Ensuring that the patient has been adequately monitored is important, but it is not the first step when considering the use of restraints. The nurse should first explore alternative interventions.
Choice B rationale
Proceeding with the application of restraints without considering alternatives can lead to unnecessary use of restraints, which can cause physical and psychological harm to the patient.
Choice C rationale
Exploring alternative interventions to address the patient’s behavior is the first step. Restraints should only be used as a last resort when other interventions have failed.
Choice D rationale
Obtaining verbal consent from the patient’s family is important, but it is not the first step. The nurse should first explore alternative interventions.

A. A 5-year-old patient admitted yesterday with pneumonia. B. A 78-year-old female with osteoporosis who needs assistance performing range of motion exercises and ambulating with a walker. C. A 78-year-old patient newly admitted with congestive heart failure. D. A 34-year-old patient post knee arthroscopy who requires reinforced crutch walking.

Correct Answer is C

Explanation

Choice A rationale
A 5-year-old patient admitted yesterday with pneumonia may require frequent assessments and interventions that are within the scope of practice for an LPN. However, the complexity of care for a newly admitted patient with a potentially unstable condition may be better suited for an RN.
Choice B rationale
A 78-year-old female with osteoporosis who needs assistance performing range of motion exercises and ambulating with a walker can be managed by an LPN. These tasks are within the LPN’s scope of practice and do not require the higher level of assessment and decision-making skills of an RN.
Choice C rationale
A 78-year-old patient newly admitted with congestive heart failure requires complex assessments, monitoring, and interventions that are within the scope of practice for an RN. The RN’s advanced skills and knowledge are necessary to manage the patient’s condition effectively.
Choice D rationale
A 34-year-old patient post knee arthroscopy who requires reinforced crutch walking can be managed by an LPN. These tasks are within the LPN’s scope of practice and do not require the higher level of assessment and decision-making skills of an RN.

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During a therapy session, a client begins to cry while discussing a traumatic experience. What is the nurse’s most appropriate response?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is considering the use of restraints. The nurse should:

Correct Answer is C

Explanation

Which client would be assigned to an RN and not an LPN?

Correct Answer is C

Explanation

A nurse is preparing an in-service program about preventing medication errors when transcribing a prescription. The nurse is using a prescription as an example. The prescription is: “Give temazepam 15mg as needed.”. What is missing from the prescription?

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A nurse at the clinic is involved in disease surveillance. What level of prevention is this?

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The nurse is collaborating with the multidisciplinary team. Which statement about collaboration is correct?

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