During an interview, a patient attempts to change the focus from ...

[Cooldude101]

During an interview, a patient attempts to change the focus from self to the nurse by asking personal questions. Select the nurse's most therapeutic response.
 
  a. Are you trying to avoid answering these questions?
  b. I am uncomfortable talking to patients about my personal life.
  c. I am sure we can solve your problems if you describe them to me.
  d. The time we spend together is for you to discuss your problems and concerns.

Question 2

A nurse reviews vital signs for a patient admitted last night with an injury sustained while intoxicated.
 
  The medical record shows these blood pressure and pulse readings: Admission, 2 AM - 118/78 mm Hg and 72 beats/min 4 AM - 126/80 mm Hg and 76 beats/min 6 AM - 128/82 mm Hg and 72 beats/min 8 AM - 132/88 mm Hg and 80 beats/min 10 AM - 148/94 mm Hg and 96 beats/min What is the nurse's priority action? a. Force fluids.
  b. Consult the health care provider.
  c. Obtain a clean-catch urine sample.
  d. Place the patient in a vest-type restraint.

[parshano]

Answer to Question 1

D
When a patient tries to focus on the nurse, the nurse should refocus the discussion back onto the patient. In the correct answer, the nurse gives this information. The distracters do not refocus discussion to the patient's needs.

Answer to Question 2

B
Elevated pulse and blood pressure may indicate impending withdrawal delirium and that additional sedation is warranted. None of the other options takes into account the possible need for sedation. No indication is present that the patient may have a urinary tract infection or is presently in need of restraint. Hydration will not resolve the problem.