Answers and Explanations

Chapter Quiz

1. The Answer is 6, 2, 4, 3, 5, 1

   The LPN/LVN is caring for the client in the pediatric unit. The client’s parents, whom the nurse has not met, approach the nurse at the nursing station. Arrange the following steps in the order that the LPN/LVN should perform them. All options must be used.

   Strategy: Picture yourself and the parents at the moment of first contact. Think about what action comes next.

   Category: Implementation/Health Promotion and Maintenance

   1. The nurse and the parents introduce themselves.
   2. The nurse brings the parents to a private area to talk.
   3. The nurse invites the parents to talk about their questions on home care.
   4. The nurse affirms the parents’ ability to take care of their child at home.
   5. The nurse follows up with literature about home care instructions.
   6. The nurse documents the significant parts of the conversation.
2. The Answer is 1

   The LPN/LVN is having a long discussion with a client diagnosed with diabetes who requires an amputation. At times during the conversation, the LPN/LVN continues looking at the client but becomes silent. Which of the following is the best advantage of this approach?

   Strategy: “Best” indicates that there may be more than one response that appears correct.

   Category: Implementation/Psychosocial Integrity

   1. CORRECT: Rather than feel pressured to respond, the client can relax for a moment and reflect on the conversation.
   2. The reason for using silence is to make the conversation more productive, not to end the dialogue.
   3. The reason for using silence is to allow quiet focus, not to provide distraction.
   4. Silence should not be used to make the client feel pressured to respond.
3. The Answer is 1

   The client says to the LPN/LVN, “I really like you and I think you really like me. Would you like to go on a date with me after I am discharged?” What is the most appropriate response by the LPN/LVN?

   Strategy: Eliminate incorrect answer choices.

   Category: Implementation/Psychosocial Integrity

   1. CORRECT: This response provides realistic information and is not confrontational.
   2. “Why” questions can be confrontational. Even though realistic information is offered in this response, the opening statement implies disapproval and might put the client on the defensive.
   3. This response is confrontational. The LPN/LVN should be able to take care of the situation right now. If the comment needs to be reported, the LPN/LVN should report it to the direct supervisor and follow the chain of command.
   4. This response puts the focus on the nurse and is not therapeutic communication. Focus should remain on the client.
4. The Answer is 4

   The LPN/LVN is caring for a client recently diagnosed with type 1 diabetes mellitus. The client says, “I just can’t believe that I am going to have to give myself shots every day.” What is the priority statement for the LPN/LVN to make?

   Strategy: Eliminate incorrect answer choices.

   Category: Implementation/Psychosocial Integrity

   1. This statement takes the focus away from the client and dismisses the client’s feelings.
   2. This is a “yes/no” question, which does not allow the client to give information or express feelings. It also assumes that the client cannot care for self.
   3. In this response, the focus is on the nurse. Remember that on the NCLEX, you have the time to provide emotional support right now.
   4. CORRECT: Even though it is a statement, this response is open-ended and encourages the client to discuss feelings. The client has expressed concern about the insulin injection but may need to discuss feelings about the diagnosis of diabetes.
5. The Answer is 3 and 6

   The LPN/LVN is working in the hospice unit. The client’s partner approaches the nurse and says, “I won’t be able to face life without my partner of over 50 years.” Which of the following would be an appropriate response by the LPN/LVN? Select all that apply.

   Strategy: For each response, remember the principles of therapeutic communication. Eliminate nontherapeutic responses to identify the best answer. You may need to “translate” responses to identify errors in therapeutic communication.

   Category: Implementation/Psychosocial Integrity

   1. The client's partner is not in the mood to celebrate; this response ignores the partner’s grief.
   2. This is an authoritarian response that instructs the client's partner to behave in a certain way, your way.
   3. CORRECT: This response is empathetic and reflects the partner's feelings.
   4. This response is a version of “Don’t worry.”
   5. This is an authoritarian response that instructs the partner to think in a certain way, your way.
   6. CORRECT: This response is empathetic and reflects the partner’s feelings.
6. The Answer is 3

   The LPN/LVN is obtaining a medical history from the client with several chronic gastrointestinal conditions. Which of the following questions would best elicit the client’s current emotional state?

   Strategy: Remember therapeutic communication. You want to hear feelings, not facts.

   Category: Data Collection/Psychosocial Integrity

   1. This is a closed-ended question that can be answered with a number or with “I don’t know.” It encourage a response that gives no insight into the client's  emotional state. 
   2. This is a closed-ended question that can be answered with a list. It seeks facts and doesn't encourage a response that gives no insight into the client's emotional state.
   3. CORRECT: This is an open-ended question that encourages the client to express feelings about the current health status and measures needed to improve it.
   4. “Why” questions imply disapproval. This question could put the client on the defensive, discouraging any expression of feelings about dietary intake.
7. The Answer is 4

   The unlicensed assistive personnel (UAP) tells the LPN/LVN, “I want to change my assignment for today. I will not take care of a client diagnosed with AIDS.” What is the most appropriate statement for the LPN/LVN to make?

   Strategy: Eliminate incorrect answer choices.

   Category: Implementation/Psychosocial Integrity

   1. This is a “yes/no” question and can be interpreted as confrontational.
   2. This response gives false reassurance and does not address the concerns of the UAP.
   3. This response is authoritarian and argumentative, and it does not address the concerns of the UAP.
   4. CORRECT: This response is open-ended and allows the UAP to express feelings about care of a client diagnosed with AIDS. It seeks more information about the UAP’s knowledge of the care needed.
8. The Answer is 3

   The teenage client in the adolescent psychiatric unit asks the LPN/LVN, “Do you hear those voices? They sound so frightening.” Which of the following responses by the nurse would be the most appropriate?

   Strategy: “Most appropriate” indicates that discrimination is required to answer the question. Remember therapeutic communication as well as scope of practice.

   Category: Implementation/Psychosocial Integrity

   1. This response contradicts the client’s experience and also moves the focus from the client to the nurse.
   2. This response affirms the client’s delusions and is exploratory; outside the scope of LPN/LVN practice.
   3. CORRECT: This response gives correct information and is empathetic, reflecting the client’s feelings.
   4. This response is unnecessarily authoritative and removes focus from the client’s needs.
9. The Answer is 2

   Family members of the client with dementia are visiting the memory care unit for the first time. They express concern to the LPN/LVN caring for their relative about the client’s unobserved wandering. Which of the following responses by the LPN/LVN would be most appropriate?

   Strategy: Remember therapeutic communication: Focus on assuring good client care.

   Category: Implementation/Psychosocial Integrity

   1. This “Don’t worry” response discounts what the family members feel.
   2. CORRECT: This response provides factual information and encourages further communication.
   3. This response moves the focus from the client to the LPN/LVN.
   4. The response negates the family members’ concern and discourages further communication.
10. The Answer is 3

    The LPN/LVN is caring for a client 5 days after a colostomy procedure. During colostomy care, the LPN/LVN observes the client vigorously rubbing the skin around the stoma before applying the colostomy pouch. What is the most appropriate statement for the LPN/LVN to make?

    Strategy: Eliminate incorrect answer choices.

    Category: Data Collection/Psychosocial Integrity

    1. Asking the client for an explanation may be deemed confrontational. Also, this is a “yes/no” question, which does not encourage the client to give information or express feelings.
    2. This question is closed-ended and judgmental. It assumes that the client does not have the ability to care for the colostomy.
    3. CORRECT: This statement gives factual information. There is an increased risk of damage to the skin if the area around the stoma is rubbed vigorously. With this approach, the LPN/LVN can provide positive reinforcement for the steps of the procedure done correctly and give suggestions for improvement.
    4. This question assumes that the client has not read the written instructions. The priority is to have the client demonstrate all steps of colostomy care.