Answer to Question 1
A, B, C, D
Agreeing and making time for conversation, using active listening skills and therapeutic touch, teaching stress reduction strategies, and informing the patient of the risk to health associated with stress are interventions that are within the nurse's scope of practice. Agreeing to witness a telephone conversation could draw the nurse into divorce proceedings when the focus should be on the patient and his health. Referring the patient to the nurse's church counselor without a specific request from the patient may not take into consideration cultural care and could be considered unprofessional. If the patient requested a marriage counselor, a better solution would be to provide a referral to social services that may include a list of possible counselors from which the patient could choose.
Answer to Question 2
D
Peripheral edema is an expected assessment finding in the client diagnosed with right-sided heart failure.
Dyspnea is an expected assessment finding in the client diagnosed with left-sided heart failure.
Confusion is a symptom of hypoventilation.
Dizziness is an expected assessment finding in the client experiencing hypoxia.
An adult male Asiatic lion
A nurse adjusts the rate of a client’s IV.
Treating the middle-aged adult
The medical assistant escorts the patient into the examination room.
Examples of endocrine disorders. (D) A patient with gigantism.
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