The nurse has used interpretation regarding a patient's statement or actions. After using this technique, it would be best for the nurse to:

Apologize, because using interpretation can be demeaning for the patient

Allow time for the patient to confirm or correct the inference

Continue with the interview as though nothing has happened

Immediately restate the nurse's conclusion on the basis of the patient's nonverbal response

Answer and Explanation

The Correct Answer is B

A. Apologize, because using interpretation can be demeaning for the patient:
Interpretation is a valid therapeutic technique when used respectfully; no apology is needed unless offense occurs.

B. Allow time for the patient to confirm or correct the inference:
This invites the patient to clarify the nurse’s understanding and promotes effective communication.

C. Continue with the interview as though nothing has happened:
Misses the opportunity for clarification and deeper understanding.

D. Immediately restate the nurse's conclusion on the basis of the patient's nonverbal response:
Jumping to conclusions without confirmation may lead to miscommunication.

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Correct Answer is B

Explanation

A. Skin appears dry:
Objective data-what the nurse observes.

B. Patient denies any colour change:
This is a verbal report from the patient and represents subjective data.

C. No lesions are obvious:
Nurse’s observation, so it is objective.

D. Lesion is noted on the lateral aspect of the right arm:
Nurse’s observation; objective data.

A. The aortic valve is best heard at the third intercostal space at the right of the midclavicular line B. The mitral valve is heard at the second intercostal space in the midclavicular line C. The tricuspid valve is heard at the fourth intercostal space at the left of the sternal border D. The pulmonic valve is heard at the fourth intercostal space at the left of the sternal border

Correct Answer is C

Explanation

A. The aortic valve is best heard at the third intercostal space at the right of the midclavicular line:
Incorrect intercostal space. Aortic valve is heard at the second intercostal space, right sternal border.

B. The mitral valve is heard at the second intercostal space in the midclavicular line:
Incorrect. Mitral valve is heard at the fifth intercostal space, midclavicular line (apex).

C. The tricuspid valve is heard at the fourth intercostal space at the left of the sternal border:
This is the accurate location for auscultating the tricuspid valve.

D. The pulmonic valve is heard at the fourth intercostal space at the left of the sternal border:
Incorrect. The pulmonic valve is heard at the second left intercostal space, not the fourth.

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The nurse has used interpretation regarding a patient's statement or actions. After using this technique, it would be best for the nurse to:

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which of these statements represents subjective data the nurse obtained from the patient regarding the patient's skin?

Correct Answer is B

Explanation

When auscultating the heart, which of the following statements is true?

Correct Answer is C

Explanation

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