NUR 300 FINAL QUESTIONS

16. The client states, "I have emphysema, so I have enrolled in a smoke-enders program." According to Prochaska, the client is in the stage of change known as: a. Action b. Determination c. Precontemplation d. Contemplation

ANS: A During the action stage of change, the client engages in concrete actions. Incorrect answers: 2. In the determination stage, the client decides there is a problem and is willing to make a change. 3. In the precontemplation stage, the client does not think there is a problem. 4. In the contemplation stage, the client thinks there may be a problem.

15. Mrs. Green is a difficult client. You are discussing her care at a team conference. Which of the following is not a positive approach for dealing with a difficult client? a. Promote trust by providing immediate feedback b. Plan and set goals for the client with the assistance of the health care team c. Use varied approaches among health team members d. Providing, not withholding, information will reduce anxiety.

ANS: A Development of trust will decrease anxiety. Incorrect answers: 2. The client should be involved in her care with the focus on mutual goals set by the nurse and client. 3. Staff should use a uniform approach when dealing with the client. 4. Providing information will reduce anxiety.

14. Which of the following is the best action when caring for a disoriented client? a. Speak in simple sentences b. Explain what you are doing c. Look at the client when speaking d. Personalize social amenities

ANS: A By speaking in simple sentences the nurse enables the older adult to use his or her remaining capabilities. Incorrect answers: 2,3,4. When nurses break down directions or requests into smaller steps and use simple sentences, they may be enabling the client to understand and accomplish a task.

9. As a nurse it is acceptable to express strong feelings of anger to: a. Nurse's family b. Strangers c. Client d. Client's family

ANS: A By using assertive communication, it is appropriate to express strong feelings of anger to family and friends. Incorrect answers: 3,4 As nurses, we affect the behavior of our clients through actions. Expressing strong feelings of anger can have negative outcomes for the client. 2. It is important to communicate with the correct person and not take your frustration out on someone else.

7. Which of the following is true about assertiveness? a. Components include ability to say no and to ask for favors b. Assertiveness responses consist of "you" statements c. Assertiveness skills are inborn d. Assertiveness allows the person to dominate

ANS: A Components of assertion are the ability to say no, to ask for what you want appropriately, express thoughts and feelings, and initiate and terminate the interaction. Incorrect answers: 2. Assertive responses consist of "I" statements. 3. Assertiveness can be learned. 4. Aggressive behavior has the goal of dominating

10. Mrs. Davidson, age 55, is recovering from a stroke. When you try to communicate with her, she nods her head when you speak and responds using a few words that are coherent to you. Which type of aphasia does Mrs. Davidson exhibit? a. Expressive aphasia b. Receptive aphasia c. Global aphasia d. Cognitive aphasia

ANS: A Expressive aphasia refers to an inability to find words or associate ideas with accurate word symbols. Incorrect answers: 2. Receptive aphasia means that the client can hear the word but has trouble associating it with what it means. 3. Global aphasia includes both receptive and expressive communication deficits. 4. Receptive aphasia sometimes limits short-term memory and this can be misinterpreted as dementia (cognitive aphasia).

13. Jim has just completed his detoxification from alcohol. His wife left him, his job is in jeopardy, and his liver enzymes are elevated. He states, "Alcohol is ruining my life, I'll do anything it takes to quit drinking." The best intervention for the nurse is to: a. Give Jim information about a 28-day addiction rehabilitation center b. Give Jim a copy of his lab results c. Have Jim complete a cost/benefit worksheet of alcohol use d. Point out positive changes

ANS: A Jim is in the determination stage of change. The approach at this stage is to assist the client in choosing the best course of action to resolve the problem. Incorrect answers: 2. This is an intervention for use in the precontemplation stage. 3. This intervention would be effective during the contemplation stage. 4. This is an intervention that would be used in the maintenance stage.

9. Amy Wong, RN, is interviewing the family of a client newly diagnosed with Alzheimer's disease. Amy wants to help the family members classify their fears and identify strengths. Amy uses: a. Interventive questioning b. Genogram c. Ecomap d. Offering commendations

ANS: A Questioning is a nursing intervention to help families identify strengths and fears and to explore options. Incorrect answers: 2. Genogram is a map of the structure of intergenerational relationships. 3. Ecomap is a means to map relationships. 4. Offering commendations is a means used to reflect family strengths back to the family

15. Mrs. Ames is an elderly client who calls you Sister Ann, even though you have introduced yourself as Mr. Wong. Prior to asking how she is, the best response to Mrs. Ames is: a. Tell her who you are b. Ask her if she wears glasses c. Ask Mrs. Ames to explain where she is d. Ask Mrs. Ames to repeat what she said

ANS: A Repetition is useful in focusing the older adult's attention. Restating and using the same words and sequence help the conversation continue. Incorrect answers: 2,3,4. The cognitively impaired client may not be able to answer these questions, and these would not be helpful in addressing the described situation.

6. It is critical to assess hearing loss in the elderly because: a. Hearing loss has a direct impact on communication b. Deafness causes hair loss c. There is an initial inability to hear low-frequency consonants d. Older adults can only hear at 90 words per minute

ANS: A Sensory deficits, including hearing loss, have a direct and significant effect on communication. Incorrect answers: 2. Loss of hair cells in the organ of Corti results in hearing loss after age 50. 3. There is an initial inability to hear high-frequency sounds. 4. Older adults can hear best at 125 words per minute

12. Your client, age 30, is coming to the wound clinic for treatment of his leg ulcers. You note that healing is not occurring and an infection is present. What statement can you make to the client that would address his stage of change? a. "Your wound culture shows some infection is present. This is a deterioration from your last visit." b. "You have had these ulcers a long time. Can you remember what it was like to be free of them?" c. "What are you going to do to improve this situation?" d. "You are good at paying attention when I change the dressing. Is there anything else I can show you today?"

ANS: A The client is in the precontemplative stage of change. The intervention at this stage is to raise awareness of a health problem. Incorrect answers: 2. This intervention is used in the contemplation stage. 3. This intervention is used in the determination stage. 4. This intervention is used in the maintenance stage.

1. You have Jamie, an unlicensed assistive person, working with you on the night shift. You delegate to Jamie the changing of beds of clients that are incontinent. When you make 6 AM rounds, you encounter a client who complains that she had to sleep in a wet bed all night. Which principle of delegation is violated in this situation? a. Oversee tasks that are delegated b. Evaluate tasks that are delegated c. Know tasks Jamie is capable of performing d. Know Jamie's readiness to perform delegated tasks

ANS: A The delegating nurse must oversee the task being done. Incorrect answers: 2,3,4. Jamie may have been capable and ready to perform the task, but the nurse did not oversee that he did the task.

11. Your client needs to learn to administer his antiviral medication. His English is limited. Your teaching plan includes: a. Including family members b. Reviewing major points c. Providing minimal information d. Answering questions honestly and factually

ANS: A The family should be included in the development, implementation, and evaluation of the plan, or it may be sabotaged when the client goes home. Incorrect answers: 2,3,4. The family should be included in education from the outset.

8. Which of the following clients with a communication deficit requires the use of touch during a therapeutic encounter? a. Blind client b. Client with a hearing loss c. Mentally ill client d. Client experiencing environmental deprivation

ANS: A The social isolation experienced by clients who are blind is profound and the need for contact is important. Incorrect answers: 2. Touch may startle the hearing-impaired client. 3. The mentally ill client requires a greater degree of personal space and use of touch may be misinterpreted. 4. This client may also misinterpret cues such as touch.

3. Which personal conflict management style do females tend to use? a. Avoidance and compromise b. Collaboration and competition c. Avoidance and collaboration d. Competition and compromise

ANS: A Women have been socialized to react in ways that will assuage the other person's anger and tend to use accommodative styles such as compromise and avoidance. Incorrect answers: 2,3,4. Men tend to use collaboration and competition styles of conflict management.

16. Your client, Mr. Sims, makes several sarcastic remarks to you while you are providing nursing care. You know that his behavior is an example of: a. The use of humor b. Use active listening c. Verbal anger cue d. Assertiveness

ANS: C Anger cues may be disguised as witty sarcasm. Incorrect answers: 1. The client's remarks are sarcastic, not humorous. 2. The client's remarks are verbal, not nonverbal. 4. Sarcasm is an example of passive- aggressive communication.

1. The Adams family consists of Robert, a 28-year-old unemployed factory worker; Ann, Robert's 20-year-old wife; and Joan, their 2-month-old daughter. The Adams have requested public assistance for food stamps. During your home visit Ann states, "My daughter needs food because I only feed her watered-down milk with cereal." Robert states, "I cannot get a job." Anne states, "You don't even try." Which of the following techniques should the nurse employ in this situation? Select all that apply. a. Reframing b. Feedback c. Circular questioning d. Supporting their coping style e. Encouraging self-awareness

ANS: A, B, C, E Reframing can often turn a negative perception into a positive one; corrective feedback through modeling and use of circular questions to encourage self-awareness help family members see their impact on others in the family. Incorrect d. The family's style of coping may not be useful

Precede components of the Precede/Proceed Model of Health Promotion include which of the following? Select all that apply. a. Social diagnosis b. Epidemiological diagnosis c. Implementation d. Outcome evaluation e. Educational diagnosis

ANS: A, B, E

8. Which of the following is the therapeutic way to acknowledge your anger to a client? a. Remain silent and do not respond b. Use an "I" message c. Use the statement, "You make me angry." d. Turn your back and walk away

ANS: B "I" messages are assertive statements that allow the sender to get the message across without suppressing the other person's rights. Incorrect answers: 1. This is passive behavior that has a negative influence on care delivery. 3. "You" statements are aggressive statements that project blame. 4. This is avoidant behavior where the issue is not addressed

4. Mary, a client recovering from her second myocardial infarction, refuses to give up smoking. She states, "I've smoked so long now there's no point quitting as the damage is done." This statement is best understood in the context of which of the following? a. Social learning theory b. Pender's health promotion model c. The trans-theoretical model of change d. Healthy People 2010

ANS: B According to Pender, a person's perceptions of benefits and barriers to health-promoting behaviors strengthen or weaken interest in participation in health-promoting behaviors. Incorrect answers: 1. In social learning theory, motivation is a fundamental component of learning readiness. 3. Motivation to change is a state of readiness that fluctuates. 4. Healthy People 2010 represents the health promotion agenda for the nation.

3. The theory that is based on the assumption that a person's behavior is closely linked to his or her functioning in the family of origin is: a. Duvall's b. Bowen's c. McCubbin's d. Minuchin's

ANS: B Bowen's system theory links patterns of behavior to those in the multigenerational family. Incorrect answers: 1. Duvall focused on life tasks. 3. McCubbin focused on coping during illness. 4. Minuchin conceptualized subsystems to organize ways in which family members interact

19. Mr. and Mrs. Hart are an elderly couple that you are interviewing at home. Mr. Hart asks to speak to you alone. He tells you that Mrs. Hart has become forgetful lately and yesterday he received an overdue tax bill. He asks, "Should I take over this responsibility?" What would you say to Mr. Hart? a. "Old people get forgetful at times" b. "Could you tell Mrs. Hart that you will help with the bill paying?" c. "Tell Mrs. Hart that you will assume the responsibility now" d. You don't know what to suggest. This is a family matter

ANS: B By encouraging spousal support, you are supporting Mrs. Hart's independence and helping her to keep her dignity even though she has become forgetful. Incorrect answers: 1. This is an example of offering cliché reassurances. 3,4. The nurse's role is to assist the older adult to explore options, rather than giving advice or not assisting with the problem.

7. When caring for the client with macular degeneration, the nurse should: a. Face the client directly b. Stand to the client's side c. Take the client's arm as a guide d. Restrict the client's contact with the environment

ANS: B Clients with macular degeneration still have some peripheral vision. Incorrect answers: 1. Clients with macular degeneration lose their central vision. 3. You should allow the client to take your arm. 4. Maintain as much contact with the environment as possible

1. Which of the following is true in relation to communication deficits? a. Communication deficits occur only as a result of physical disabilities b. Communication deficits can arise from sensory deprivation c. Individuals that are equally impaired are equally disabled d. The primary nursing goal is to minimize the client's independence.

ANS: B Communication deficits can occur in intensive care units related to temporary immobility and environmental limitations. Incorrect answers: 1. Deficits occur as a result of physical disabilities and sensory deprivation. 3. Impairment does not equal disability. 4. The primary nursing goal is to maximize client independence

11. You are interviewing the Brown family. You ask Jerry, the 14-year-old son, to respond to the question, "How has your mother's illness affected you?" Tom, Jerry's father, states, "He has been angry, irritable, not helping around the house, and missing school." You respond by: a. Responding to Tom and addressing him directly b. Addressing Jerry directly, not responding to Tom c. Repeating the question to Sheri, Jerry's 12-year-old sister d. Clarifying the behavior by questioning the mother

ANS: B Corrective feedback is used in this situation when Tom, the father, speaks for his son. The nurse does not respond to Tom, but addresses Jerry, the son, directly. Incorrect answers: 1,3,4. When giving corrective feedback, the nurse role-models appropriate communication by not responding to someone who speaks for another. Family members are then able to infer appropriate communication from the nurse's behavior.

2. Your client, Mr. Harold, refuses to attend the team meeting. He tells you that there is no point in going because he does not get anything out of it. You suspect he is suffering from hearing loss. You know that: a. He will readily acknowledge that this is the problem if asked b. He may try to hide his deficits by withdrawing from relationships c. Decreased hearing ability is not related to conversational style d. Older adults have better consonant discrimination

ANS: B Deprived of a primary means of receiving signals, the client may try to hide his deficit and withdraw from relationships. Incorrect answers: 1. He may try to hide his deficit. 3. Research shows that decreased hearing ability is related to changes in conversational style. 4. Older adults have poorer consonant discrimination

13. You are providing home health care to a client suffering from Alzheimer's disease who fell and broke his hip 3 weeks ago. You teach the family the use of the walker. This represents which stage of the nurse-caregiver relationship? a. Worker-helper b. Worker-worker c. Manager-worker d. Nurse as nurse for family caregiver

ANS: B During the worker-worker stage, the nurse teaches care skills to family members. Incorrect answers: 1 In the worker-helper stage, the nurse provides care to the ill client with the family helping. 3. In the manager-worker stage, the nurse acts as manager with the family learning care skills. 4. In this stage the family member is exhausted and the nurse cares for him/her as well as the client DIF: Cognitive Level: Application, Knowledge REF: Text Page Reference: p. 336 TOP: Step of the Nursing Process: Interventions MSC: Client Needs: Management of Care

7. Which family theory uses developmental tasks as a framework? a. Bowen b. Duvall c. Systems theory d. McCubbin

ANS: B Duvall's model looks at the family's developmental process of growth, aging, and change over its life span. Incorrect answers: 1,3. Bowen uses a systems theory. 4. McCubbin's model is a resiliency model of family stress.

3. Mr. Adams, age 85, tells you, "My life has been a waste." This statement demonstrates which aspect of psychosocial development? a. Ego integrity b. Ego despair c. Lack of generativity d. Isolation

ANS: B Ego despair is defined as a failure to accept one's life as meaningful. Incorrect answers: 1. Ego integrity relates to the capacity to look back on life with a deep sense of satisfaction. 3. Generatively vs. stagnation occurs in the adult stage of development. 4. Intimacy vs. isolation occurs in the young adult stage of development.

14. Your client, Grace Smith, does not respond verbally to you. As a nurse in the ICU, you should: a. Frequently change her position for physiological benefit only b. Continue to talk to the client c. Not explain procedures because the client will not understand d. Create a less stimulating environment

ANS: B Even if the client is unwilling or unable to talk, the nurse should continue to communicate in a one-way mode. Incorrect answers: 1. The client should not stare at a blank wall or ceiling for long periods. Frequent position changes offer an opportunity for the nurse to communicate with the client. 3. The nurse needs to explain all procedures to the client. 4. The nurse needs to create a more stimulating environment.

1. The assessment of the older adult should focus on: a. Chronological age b. Functional level c. Relationship needs d. Social functioning

ANS: B Functional level is a more accurate indication of client needs. Functional abilities can range from vigorous and independent to frail and dependent regardless of chronological age. Incorrect answers: 1. The span of old age covers more than 30 years, so the assessment should focus on functional ability rather than age in years. 3,4. The functional level is a more accurate indicator of relationship needs and social functioning than chronological age.

13. Mrs. Evans is unconscious in the intensive care unit following complications of surgery. A family member reports to you that a nurse at Mrs. Evans' bedside said, "I wouldn't want to live in her condition." What did this nurse not realize about Mrs. Evans' capabilities? a. The client can read lips b. The client can hear what the nurse says c. The client can respond to statements via written communication d. The client can be sensitive to the nurse's nonverbal behavior

ANS: B Hearing is the last sense to go. The nurse should not say anything she would not want the client to hear. Incorrect answers: 1,3,4. These answers do not relate to the verbal statement made by the nurse.

14. Which of the following is a true statement when comparing biological and blended families? a. In biological families, rules are varied and complex b. A blended family is born of loss c. In biological families there are multiple sets of rules d. In blended families traditions are shared

ANS: B In blended families, there has been a loss of a biological parent, partner. Incorrect answers: 1. In blended families rules are varied and complicated. 3. There is one set of rules in biological families. 4. There are two sets of family traditions in blended families.

5. You have identified loneliness as a problem for Gladys, your 83-year-old client. This problem is associated with which level of Maslow's hierarchy of needs? a. Biological integrity b. Belonging c. Self-actualization d. Self-esteem

ANS: B Loneliness is associated with Maslow's third level on the hierarchy: belonging (e.g., friends or group affiliation). Incorrect answers: 1. Biological integrity is associated with the problem of disorientation. 3. Self-actualization is associated with the problem of apathy. 4. Self-esteem is associated with the problem of depression

17. Three-year-old Jenna is having surgery tomorrow. A preoperative teaching strategy the nurse should use is: a. Encourage self-directed learning b. Involve parents in teaching c. Allow child to touch and play with all equipment d. Incorporate previous life experience

ANS: B Parents can provide useful information and commonly used words to incorporate into the teaching. Incorrect answers: 1,4. These are principles of adult learning. 3. The child should touch and play with safe equipment.

15. The belief in one's ability to execute actions required to achieve a goal is known as: a. Social incentive b. Self-efficacy c. Cognitive motivator d. Physical motivator

ANS: B Self-efficacy is the belief in one's ability to execute actions that are necessary to achieve a goal. Incorrect answers: 1,3,4. These are motivating factors.

18. The initial interpersonal strategy to help the client reduce strong emotion involves: a. Talking b. Environment c. Action d. Obtaining more information

ANS: B The initial step involves providing a neutral, accepting, interpersonal environment. Incorrect answers: 1. Talking the emotion through occurs in the second stage. 3,4. The third phase is to take action, which might take the form of obtaining more information.

1. Your client, Mr. Smith, is shouting at you and demanding to see his physician. Although it is difficult, you know that the best response to use is: a. Defensiveness b. Empathy c. Aggression d. Use of "I" statements

ANS: B The nurse's best response is to remain calm and empathize with what the client is experiencing. Incorrect answers: 1,3. Becoming defensive or aggressive will escalate the situation. 4. It is better to allow ventilation of "emotional steam" before engaging in conversation.

2. Mr. and Mrs. Barnes are an elderly couple who were traveling across the country in their mobile home when Mrs. Barnes developed acute abdominal pain and had to be hospitalized. Mr. Barnes states to you, "I don't know what I would do if she doesn't make it." Mrs. Barnes states, "We must continue this trip, because it may be my last one." What nursing diagnosis is appropriate for this situation? a. Ineffective individual coping by Mr. Barnes b. Ineffective family coping c. Knowledge deficit d. Alteration in role expectation

ANS: B The problem in this situation is the failure of the couple to communicate their concerns to each other. Incorrect answers: 1. The problem is not their individual concerns; it is the failure to communicate concerns to each other. 3. There is no evidence of knowledge deficit in the situation. 4. The problem is coping together as a family, not altered role function.

4. You are conducting a goal-setting group on your unit. When it comes to Clara Jones's turn, she states, "I feel old. I just feel so old and that I have nothing in common with anyone here." In planning interventions for Clara, it is important to: a. Find other clients on the unit with whom Clara can identify b. Help her to identify strengths that she has used in the past c. Allow family members to visit more frequently d. Have her work on a craft in recreational therapy

ANS: B The strengths of the client form the basis for planning and intervention. Incorrect answers: 1,3,4. Successful past achievements can be used as tools to help the client take control of her life.

6. When caring for a client with hearing loss, which of the following interventions is indicated? a. Speak louder b. Make gestures using hands c. Speak in a normal manner d. Make tactile contact

ANS: B The use of gestures and facial expressions reinforces the verbal content. You should speak in a moderate, even-tone and articulate words clearly. Incorrect answers: 1,3. You should speak in a moderate, even tone and articulate words clearly. 4. Tactile contact may startle the client. Tap on the floor or table to get the client's attention via vibration

12. After fasting from 10 PM the previous evening, your client, Gladys Evans, finds out that her test has been cancelled. She curses at you and states that you are incompetent. Your best response would be: a. "You have no right to say that to me. You are nasty" b. "I can understand you being upset, but I feel uncomfortable when you swear at me" c. "We need to learn to control our anger!" d. Leave the room and refuse to return to answer the call light when she calls

ANS: B This is an assertive statement that validates what the client is feeling but also lets the client know how her behavior has affected the nurse. Incorrect answers: 1. This is a "you" statement that is accusatory and lays blame on the person, not the behavior. 3 This is a "we" statement that is condescending to the client. 4. This is a passive-aggressive behavior on the part of the nurse.

15. Mrs. Green is being cared for in the ICU, following an extensive right-sided CVA. A question that you might ask Mrs. Green's family in order to address their need for relief of anxiety would be: a. "Who best understands what the doctors have told you?" b. "What do you do when your mother cries?" c. "Who is most uncomfortable at the bedside?" d. "Who is now taking care of the house?"

ANS: B This is an example of a Behavioral Effect question that addresses the family's need for relief of anxiety. Incorrect answers: 1. This is an example of a question that addresses the need for information. 3. This is an example of a difference question that addresses the need to be with and be helpful to the patient. 4. This is an example of a difference question that addresses the need to alter and adjust to new roles

10. A client states to you in a hostile voice, "I am sick of being poked at and stuck with needles. Go away and leave me alone." Which of the following is the best intervention? a. "I am not surprised that you wish to be left alone." b. "I know you have had many examinations and treatments." c. "You feel vulnerable and depressed as a result of all these treatments." d. "OK, I will go away."

ANS: B This is the most useful intervention. The client's anger is validated and the situation is reframed in a more adaptive manner. Incorrect answers: 1. This validates the client's anger, but does not reframe the situation. 3. The nurse is making inferences about what the client is feeling without first validating. 4. This is avoidant behavior by the nurse.

6. Mary and Joe are discussing the day's events at dinner. Joe states, "I quit my job today." Mary becomes angry and responds, "How dare you do that without discussing it with me!" Joe states, "I did discuss it with our friend June." Mary leaves the room. Identify the family behavior a. Scapegoating b. Triangulation c. Placating d. Blaming

ANS: B Triangulation occurs when a third person is brought in to stabilize the tension between two members. Incorrect answers: 1. Scapegoating occurs when anxiety is projected onto a member. 3. Placating is agreeing with another despite reservations. 4 Blaming refers to not taking personal responsibility.

8. Which of the following is the best intervention for a client who is illiterate? a. Speak loudly and clearly b. Use symbols and images c. Personalize speech by using first name d. Use touch with speech

ANS: B Using symbols and images with which the client is familiar helps overcome the barriers of low literacy. Incorrect answers: 1. The client with low literacy is not necessarily hard of hearing. 3,4. These do not help with understanding

5. The dysfunctional child, family hero, and family scapegoat are examples of: a. Multigenerational transmission b. Family projection process c. Sibling position d. Triangulation

ANS: B When family tensions become too high, the family unconsciously projects their anxiety onto one of its own members. Incorrect answers: 1. Multigenerational transmission refers to families passing behavior patterns from generation to generation. 3. Sibling position refers to the impact of birth order on development. 4. A triangle is a three-person emotional system that begins when there is tension between two members.

9. When caring for a client who is blind, the most important thing the nurse should remember is to: a. Use tactile stimuli b. Explain her actions to the client c. Use Braille materials with the client d. Provide the client with information regarding resources for the blind

ANS: B You need to use words to supply additional information to counterbalance missing visual cues. Incorrect answers: 1,3,4. These interventions are useful, but the most important intervention is vocal cues

12. The loss of the ability to take purposeful action when there appears to be no muscular or sensory impairment is known as: a. Presbycusis b. Obstinance c. Apraxia d. Echolalia

ANS: C Apraxia causes a person to appear to register a command, but then to act in a manner that suggests little understanding. Incorrect answers: 1. Presbycusis is a loss in the ability to hear high-frequency sounds. 2. The nurse may interpret apraxia as the client being uncooperative or obstinate. 3. Echolalia is also known as parroting: the person repeats what another person says

6. Which of the following describes assertiveness? a. Insisting on doing things your way b. Getting even c. Standing up for yourself d. Fighting back

ANS: C Assertiveness allows a person to stand up for their rights without putting the other person down. Incorrect answers: 1,4. These are examples of aggressive behavior. 2. This is passive-aggressive behavior

3. Contributing factors in physician-nurse conflict include: a. Assertive nurses b. Well-educated nurses c. Physician attitude d. Changes in society

ANS: C Attitudes of physicians that the nurse is not a professional partner, but is an accessory, and the belief by physicians that they are the only legitimate authority contribute to conflict. Incorrect answers: 1,2,4. Assertive, well-educated nurses as well as changes in society and health care are factors that are helping to decrease conflict.

2. The idea that each person in the family influences every other family member is called: a. Equifinality b. Closed boundaries c. Circular causality d. Entropy

ANS: C Circular causality asserts that a change in one part of the system creates a change in the whole system. Incorrect answers: 1. Equifinality is the idea that the same endpoint can be created from a number of starting points. 2. Closed boundaries refer to the limiting of interaction with the external environment. 3. Entropy is energy that creates disorganization and chaos within the system.

10. You are interviewing the family of a client who is suffering from alcoholism. The communication technique you use is called circular questioning. The advantage of this technique is that it: a. Examines relationships b. Aids the nurse in establishing a diagnosis c. Identifies the impact on the family of the illness d. Helps the nurse gain specific information

ANS: C Circular questioning allows open discussion so family members can hear other members' concerns and can reflect on the meaning of their own concerns. Incorrect answers: 1. A technique used to examine relationships is called ecomap. 2. Circular questioning assists the nurse in developing interventions, not diagnoses. 3. Circular questioning helps the nurse gain multidimensional, not specific, information

16. Your client, Mr. Jones, is deaf and legally blind in his right eye. He has just had cataract surgery on his left eye. You know that: a. You should hold his arm and lead him to the bathroom b. Verbal speech is useless in this situation c. You should develop signs and signals to communicate d. You should not touch the client because this will startle him

ANS: C Develop and use signs and signals to identify yourself and give directions to the client. Incorrect answers: 1. You must let the client take your arm. 2. The client should be encouraged to use verbal speech. 4. Touch is important for the client who is blind. Let the client know you are there via use of tapping/vibration

5. Even though Mrs. Green's cholesterol level is elevated, she continues to eat red meat and fried foods. Which stage of change is Mrs. Green experiencing? a. Determination b. Action c. Precontemplation d. Contemplation

ANS: C In the precontemplation stage, the individual does not think there is a problem and is not considering change. Incorrect answers: 1. In the determination stage, the person decides there is a problem and is willing to change. 2. In this stage the individual engages in concrete actions to effect change. 3. During contemplation the person thinks there may be a problem and contemplates change.

11. Mrs. Martin is a 74-year-old woman. You introduce yourself as Miss Gordon. Mrs. Martin states, "Do you know where the bathroom is? This is not my home. Please Angie, get me out of here. My parents will be wondering where I am." Select the relevant nursing diagnosis for Mrs. Martin. a. Impaired sensory input b. Impaired verbal communication c. Alteration in thought process d. Knowledge deficit

ANS: C Mrs. Martin is disoriented to time and place. Incorrect answers: 1. There is no indication that the client has sensory deficits. 2. The client's speech/language skills are intact. 4. The problem is not a lack of knowledge, but cognitive impairment.

9. You are assessing Albert Green's need for support services. He is an 85-year-old man who was hospitalized after falling on the sidewalk. He lives alone. He seems reluctant to accept assistance. You know that this is likely because of his fear of: a. Not being able to pay for services b. Putting financial burden on his family c. Loss of independence d. Loss of privacy

ANS: C Older adults may minimize difficulties and refuse services because of their fear of loss of independent living. They often associate accepting help as the first step toward a nursing home. Incorrect answers: 1,2,4. These are concerns, but the main unexpressed fear of the elderly is loss of independence.

5. Mike makes a derogatory statement to you in front of a client. You confront him about his verbal behavior. Which of the following is the best statement to defuse the situation? a. Say to Mike the next day, "Did you know your behavior affects my job satisfaction?" b. At the end of the shift inform Mike, "I felt embarrassed in front of Mr. Adams when you criticized my care." c. "Mike, I did not appreciate the behavior you just displayed in there." d. Gain your composure and state, "Mike, I am a good nurse, so don't criticize me again in front of a client."

ANS: C Once a putdown is recognized, the nurse needs to respond immediately in an assertive manner. Incorrect answers: 1. This response occurred too long after the incident. 2,4. In these responses the nurse is justifying why she needs to speak to Mike and is sounding defensive and apologetic.

6. You are feeling anxious around a colleague and realize this is because of conflicting values. You consider seeking peer negotiation because you are aware that: a. Friction can turn relationships from competitive to collaborative b. It is appropriate to seek peer negotiation when personal conflict occurs c. Concrete, observable facts related to the issue should be the focus d. Sharing feelings about a conflict increases the intensity

ANS: C Personal feelings should not be discussed during peer negotiation. You should discuss concrete, observable facts. Incorrect answers: 1. Friction can turn relationships from collaborative to competitive. 4. Sharing feelings decreases the intensity of the conflict.

15. You are attempting to communicate a procedure to your Spanish-speaking client. A strategy that you could use to facilitate understanding would be: a. Speak loudly b. Have the client's child interpret c. Use visual aids such as pictures d. Become bilingual

ANS: C Pictures and photographs can be used to facilitate communication. Incorrect answers: 1. Speaking loudly will not facilitate understanding. 2. Children should not be used to translate. 4. The nurse does not necessarily need to be bilingual to communicate with a client who does not speak English.

16. The following diagram is an indication of: a. Divorced couple, 1 female, 1 male child b. Married couple, 1 male, 1 female child c. Married couple, 1 miscarriage, 1 living female child d. Married couple, 1 miscarriage, 1 living male child

ANS: C The diagrammatic representation of a miscarriage is a triangle. Incorrect answers: 1 The diagram represents a married couple with 1 female child and 1 miscarriage. 2. The symbol representing a male is a square. 4. The symbol representing a male is not a circle

18. At the initial meeting with the Jones family, the nurse: a. Agrees to provide transportation for them when she realizes they are overloaded b. Analyzes data and summarizes needs c. Defines the family's concerns d. Helps the various family members coordinate resources

ANS: C The first meeting is a time to gather information and to define concerns. Incorrect answers: 1. The nurse needs to set limits on unrealistic demands. 2. This occurs after the initial meeting in the planning phase. 4. This occurs during the intervention phase

1. Which of the following statements about health teaching is true? a. The nurse assures the outcome of health teaching b. The client is responsible for the quality of the health teaching c. Only the client can ensure the outcome of the health teaching d. The outcomes match the effort put into the teaching

ANS: C The nurse is responsible for the quality of the teaching, but only the client can ensure the outcome. Incorrect answers: 1,2. The nurse is responsible for the quality of the health teaching; only the client can ensure the outcome. 4. The outcome does not necessarily match the teaching effort.

12. Joanne is a psychotic college student who has been observed standing in the main hallway for the past 3 days. She has not interacted with anyone. As a nursing student, how would you begin an interpersonal communication with Joanne? a. Ask Joanne if she will let you examine her ears b. Consult with staff nurses regarding the correct intervention. c. Approach Joanne, make eye contact, and ask how she feels d. Acknowledge Joanne's presence each time you are within a close distance

ANS: C The nurse needs to use simple, concrete sentences and maintain eye contact while speaking in a calm voice. Incorrect answers: 2. As a nursing student, you can intervene. 1,4. You want to avoid close contact or crowding the client's personal space.

4. Jane worries about what other people think of her. She needs acceptance and approval from others. You know that she is showing: a. Self-differentiation b. Emotional cutoff c. Poor self-differentiation d. Rigid boundaries

ANS: C The poorly self-differentiated person depends on others for their self-identity. Incorrect answers: 1. A self-differentiated person is able to think, feel, and act for herself/himself as a separate person without being at the mercy and whims of others. 2. Emotional cutoff is when an individual breaks off contact with family members. 4. Rigid boundaries refers to little interaction between family members as well as keeping family secrets.

11. Mr. Bates is a client who has experienced global aphasia secondary to a stroke. Which of the following interventions is most appropriate for this client? a. Provide an explanation of what you are doing while you are providing care b. Consult with family about the best individualized intervention. c. Tune the client's radio to a station that is familiar to the client d. Spend long periods of time talking with the client to provide stimulation.

ANS: C The radio provides connections to a social environment without exerting pressure on the client to talk. The radio provides mental stimulation in a nontaxing way. Incorrect answers: 1. Lengthy, continuous conversations should be avoided. 2. The client may need to learn new creative ways to communicate. 4. Frequent short talks are more beneficial

1. A self-identified group whose association is characterized by special terms including strong emotional ties and durability of members describes: a. Family function b. Family process c. Family d. Family ecomap

ANS: C This is the definition of a family. Incorrect answers: 1. Family function refers to the roles people take in their families. 2. Family process refers to the communication that takes place in a family. 4. A family ecomap is a tool used to identify contacts between the family and their social environment

17. Your client, Jim, is disoriented and exhibiting psychotic symptoms. You suspect ICU psychosis. What is a strategy that would not be useful in this situation? a. Display pictures from home b. Place a clock and calendar within view c. Dim the lights and leave the client alone d. Reassure the client that cognitive psychological disturbances are common

ANS: C This would not be useful; dimming the lights and leaving the client isolated can increase psychosis and fear. Incorrect answers: 1,2. It is important to frequently orient client by providing cues. 4. Reassuring the client that cognitive psychological disturbances are common can reduce fear.

17. The nurse's first response in dealing with a conflict situation that involves a client is to: a. Identify available options b. Stay focused on the issue c. Do a self-assessment d. Separate the problem from the client

ANS: C To accomplish conflict resolution, you first need to have a clear understanding of your own personal response patterns. Incorrect answers: 1,2,4. These are all principles of conflict resolution, but the first response is self-assessment.

14. Your client, Mr. Graham, yells "Take this mess away from here. How could anyone eat this food? What kind of place are you running here?" You use your skills of assertiveness to promote change that is focused on: a. Feelings b. Attitudes c. Behaviors d. Motivation

ANS: C Undesired behaviors are the focus for change. Incorrect answers: 1,2,4. Feelings, attitudes, and motivations are not the focus for change.

16. When communicating with cognitively impaired elderly clients, it is important to understand the use of touch. Which of the following is true in relation to using touch with the elderly? a. It increases their agitation and confusion b. It is calming c. The use of touch must be determined on an individual basis d. The face should be touched to establish rapport

ANS: C Use of touch must be appropriate and determined on an individual basis. Incorrect answers: 1,2. It can cause agitation and confusion for some clients and be calming for others. 4. The face should not be touched until rapport has been established

9. Which of the following teaching strategies is recommended for a client who is newly diagnosed with diabetes at age 75 and has a low literacy level? a. Relate teaching to client's immediate experience b. Give choices and multiple perspectives. c. Use a multi-sensory approach in the lesson plan d. Encourage self-directed learning

ANS: C Visual aids provide cues to help the client understand meanings. Planning formats that involve more than one sense help the client to learn. Incorrect answers: 1. Teaching should be related to past experience. 2. Teaching should be kept simple and structured. 4. Self-directed learning is an approach used with adult learners, but is not recommended for the elderly or illiterate

2. The concept of well-being consists of the ability to: a. Work at producing an income b. Perform activities of daily living c. Define it personally d. Partner with a health professional

ANS: C Well-being is a subjective experience, always defined by the client. Incorrect answers: 1,2. Well-being is associated with personal satisfaction in six dimensions. 4. The concept of well-being is a personal experience

13. Which of the following describes the dyad family unit? a. A father and mother with one or more children living together b. First, second, and third generation members not living together c. Husband and wife living separately, each with one child d. Husband and wife living alone without children

ANS: D A dyad family is a couple living alone without children. Incorrect answers: 1. This is a nuclear family 2. This describes an extended family. 3. This describes a single-parent family.

8. You are a nurse performing the assessment of a family in crisis. Which of the following tools would you use to describe family life events and patterns? a. Ecomap b. Gender gram c. Family time lines d. Genogram

ANS: D A genogram is the most appropriate tool to use when identifying family patterns. A genogram records information about family members and their relationships for at least three generations. Incorrect answers: 1 The ecomap enhances the information learned from the genogram. 2. The gender gram is used to trace implications of gender roles in family dynamics. 3. Family time lines may show such things as patterns of early death, which can be useful when looking at how family history interacts with current health issues.

4. When communicating with Jane, a client diagnosed with chronic schizophrenia, it is important to recognize: a. Psychotic clients' sensory channels are not intact b. Clients with autism and depression have the most difficulties communicating c. Clients with schizophrenia are usually hyperverbal d. Psychotic clients may suffer from social isolation, impaired coping, and low self- esteem

ANS: D As a result of the client's inability to receive or express language signals, the client may suffer from social isolation, impaired coping, and low self-esteem. Incorrect answers: 1. Psychotic clients' sensory channels are intact. 2. Clients that have autism and schizophrenia have the worst communication deficits. 3. Clients with schizophrenia usually present with a poverty of speech and limited content.

10. You are making a home visit to Mr. and Mrs. Andrews. You note that Mrs. Andrews frequently shifts the conversation to reminisce. Which of the following communication techniques would be most effective with Mrs. Andrews? a. Restating b. Changing the subject c. Giving information d. Asking exploring questions

ANS: D Asking exploring questions will give you an opportunity to gain insight into the person. Incorrect answers: 1,2,3. These statements do not encourage the person to reminisce, which can increase self- esteem, mood, morale, and socialization.

17. You want to promote autonomy and independence of your cognitively impaired elderly client, Mrs. Brant, in the performance of ADLs (activities of daily living). The most beneficial instructions to your client would be: a. "Let's brush our teeth now dear." b. "I want you to brush your teeth." c. "Do you want to brush your teeth?" d. "Mrs. Brant, take the lid off the toothpaste. Now put the brush under the water."

ANS: D Breaking down the instructions into smaller steps may make the activity possible and reinforce self- esteem. Incorrect answers: 1. This is an example of the use of parenting behavior by the nurse, which is demeaning to the elderly client. 2. Asking her to do the whole task may not be comprehensible to the client. 3. The client may say no, but not really mean no.

14. Which of the following strategies in health education does the U.S Preventive Services Task Force recommend? a. Use a standard teaching format b. Eliminate established behaviors c. Provide general information d. Suggest small changes rather than large ones

ANS: D Change occurs in small increments depending on the stage of readiness to learn. Incorrect answers: 1. Match the teaching to the individual. 2. New behaviors are added, rather than elimination of old ones. 3. Specific information is provided.

18. According to Chen, the most culturally appropriate approach for improving the health status of ethno-cultural populations is to: a. Provide interesting teaching formats b. Encourage active involvement of the learner c. Use interpreters d. Use indigenous teachers

ANS: D Client motivation and participation increase with the use of indigenous teachers. Incorrect answers: 1,2,3. These teaching strategies and elements of readiness to learn are not described by Chen as the most culturally appropriate approach.

4. The most positive personal conflict management style is: a. Accommodation b. Avoidance c. Competition d. Collaboration

ANS: D Collaboration is a solution-oriented response. It is a win-win situation. Incorrect answers: 1. Accommodation is a lose-win situation. 2. Avoidance can turn into a lose-lose situation. 3. Competition can lead to a lose-lose situation

10. You know that educational interventions must be tailored to the individual's developmental level. Which of the following statements is true in relation to developmental level? a. School-age children are not interested in learning better ways to take care of themselves b. Adult learners absorb information best when the focus is theoretical. c. Long formats assist with elderly clients' learning needs d. Previous life experience should be incorporated into the teaching plan of adult learners

ANS: D Experience is a rich source that can be used to help with new learning experiences. Incorrect answers: 1. School-age children are very interested in learning how to care for themselves. 2. Adult learners learn best when they can apply the education to their own lives. 3. Short formats should be used with elderly clients

19. When defining the problem, it is important for the nurse to understand that: a. Families act in the best interests of their members b. A family's definition will mirror that of the individual family members c. The nurse must clearly define the problem for the family d. Each family member's perspective may differ

ANS: D Individual family members definitions of the problem may differ. Incorrect answers: 1. Families do not always act in the best interests of their members. 2. The family's definition may be different than that of individual members. 3. The nurse assists the family in defining the problem

5. You want to purchase a motorcycle for cheap, convenient transportation. You also want to have money for college tuition. The feeling you most probably exhibit at this time would be: a. Overt conflict b. Felt conflict c. Interpersonal conflict d. Intrapersonal conflict

ANS: D Intrapersonal conflict represents opposing feelings within an individual. Incorrect answers: 1. Overt conflict is observable and expressed verbally. 2. This refers to a generalized feeling of uneasiness or covert conflict. 3. Interpersonal conflict occurs between people.

11. You find Mr. Greg, a client diagnosed with psychotic disorder NOS, pacing and occasionally punching at the wall. Your first response should be to: a. Assertively tell him to stop that behavior b. Suggest that he write in his journal to help him calm down c. Speak in a loud voice to alert other staff members d. Ensure that there is plenty of physical space between you and the client

ANS: D It is important for the nurse's safety that she not get too close to this client. Incorrect answers: 2. Psychotic clients can be unpredictable and at this point he would not be likely to respond positively to a suggestion such as writing in his journal. 1,3. Speaking assertively

2. Which of the following is true in relation to conflict? a. Conflict is always negative b. Conflict does not occur in every relationship. c. Conflict is not a natural part of human relationships. d. All conflict produces stress

ANS: D It is true that all conflict produces stress. Incorrect answers: 1. Conflict can be positive. 2. Conflicts are inevitable. 3. Conflict is a natural part of human relationships

13. You are caring for Mrs. Greg, a client who has a moderate cognitive disability. You know that when developing a relationship with her it is important to know that: a. Recent memory is retained longer than remote memory b. Elderly clients like to give material gifts c. Reminiscing about the past can cause distress d. Reminiscing about the past can improve verbal communication

ANS: D Mentally impaired persons become more verbal when allowed to reminiscence. Incorrect answers: 1. Remote memory is retained longer than recent memory. 2. In sharing a memory with the nurse, the client is giving a gift. 3. Reminiscing about the past allows the client to connect verbally and share. This decreases anxiety

18. A condition of aging that interferes with accommodation of the lens of the eye is known as: a. Receptive aphasia b. Autism c. Presbycusis d. Presbyopia

ANS: D Presbyopia—as we age, the lens of our eyes become less flexible. Incorrect answers: 1. Receptive aphasia is a neurological linguistic deficit. 2. Autism is a childhood disorder characterized by a profound inability to communicate. 3. Presbycusis is a sensorineural dysfunction

7. You are supervising the administration of insulin to your client, who has had insulin-dependant diabetes for several years. You observe that he is doing some things incorrectly. It is important to remember that: a. Learning is smooth and linear b. The learning process is not affected by life events c. The nurse needs to challenge learning patterns d. Previous knowledge can be a barrier to learning

ANS: D Previous knowledge can present barriers and confusion for the client in learning new information. Incorrect answers: 1. Learning is never smooth and linear. 2. Life events have a significant bearing on the learning process. 3. Rather than challenging learning patterns, the nurse needs to understand and incorporate them

12. You are conducting the final meeting with the Jones family. You know that in terminating with the family, there are specific issues to address. Which of the following is an important consideration when terminating with this family? a. The meeting should be kept very short and to the point b. Ensure that the family has your home number in case of emergencies c. Ensure that the family needs have been met d. Ensure family awareness of progress towards goals

ANS: D Progress towards goals is summarized so that the family is aware of what happened and what was gained. Incorrect answers: 1. The final meeting should not be kept short. Both nurse and family will want to leave the meeting with a clear sense of what has happened. 2. It must be clear that the nurse's involvement with the family has ended. 3. Needs may not have been met completely. There may be the need for follow-up with other resources.

5. Which of the following describes what happens to the client who experiences environmental deprivation such as a stay within the intensive care unit? a. Cannot process and respond appropriately to sensory input because of physical immobility b. Unable to decode the meaning of messages because of physical immobility c. Cannot respond appropriately to changes in the environment because of physical immobility d. Experiences changes in cognitive equilibrium because of nature of unit and physical immobility

ANS: D Temporary reversible changes in cognitive equilibrium occur because there are few organizing structures to anchor the client. The client is surrounded by high-tech equipment and often does not have a window to orient self, and family members are excluded. Incorrect answers: 1,2,3. The cognitive decline is related to the absence of interpersonal stimulation

3. Which of the following is an example of tertiary prevention? a. Stress management program b. Prenatal clinic c. Annual gynecology examination d. Diabetic meal planning class

ANS: D Tertiary prevention is aimed at minimizing the handicapping effects of a disease. Incorrect answers: 1,2,3. These describe primary prevention strategies.

7. You have assessed significant hearing loss in your 70-year-old client, Jim Grant. You are planning interventions to assist him. An appropriate intervention would be: a. Introduce yourself first b. Shout into his good ear c. Teach Mr. Grant sign language d. Check his hearing aid batteries

ANS: D The elderly client may not realize that his batteries need replacement, or he may lack the manual dexterity to replace them. Incorrect answers: 1. Always address the person by name before beginning to speak. 2. Speak distinctly in a normal voice. 3. Use gestures to expand the meaning of the message

6. Robert, age 26, loves to eat and weighs 300 pounds. He is admitted to the hospital for a breathing problem associated with walking a short distance. Which of the following statements reflects Bandura's social theory? a. "Robert, your cardiac studies reveal an enlarged heart. This is a sign of cardiac problems" b. "Robert, I know you love to eat, but your current life style is not conducive to good health" c. "Robert, can you remember what it was like to get up and go to work every day? Your buddies miss you" d. "Robert, I am concerned about your continuing to eat large amounts because it affects your weight. I understand you lost your job as a security guard because you could not stay on your feet for long periods."

ANS: D The nurse can use her understanding of the different types of motivators to improve learning readiness. In this statement the nurse is using physical motivators and social incentives. Incorrect answers: 1,2,3. These are interventions used with the trans-theoretical model of change.

18. Catastrophic reactions can occur in the cognitively impaired elderly. An appropriate way of handling this type of reaction is to: a. Directly confront the client b. Ask the client to act more civilized c. Tell the client he/she is acting like a baby having a temper tantrum d. Use distraction

ANS: D The nurse should use distraction to move the client away from the offending stimuli. Incorrect answers: 1,2,3. Direct confrontation and an appeal for more civilized behavior tend to escalate the situation.

2. Which of the following statements is true about conflict? a. Conflict is detrimental to productivity b. It is necessary to deal with all interpersonal conflicts c. The focus of conflict strategies is on the status relations of the health care providers d. A different type of relationship can be developed using conflict management techniques

ANS: D The primary goal in dealing with workplace conflict is to find a mutually acceptable win-win strategy. Incorrect answers: 1. In many cases successful conflict resolution can have a positive effect on productivity and job satisfaction. 2. If interpersonal conflict is not handled, it will reappear and affect performance. 3. The focus should be on health goals and not status relations.

20. When performing a mental status examination on an elderly client, you discover that he is illiterate and only has third-grade education. How would you assess cognition? a. Have him spell WORLD backwards b. Have him spell WORLD forwards c. Ask him to perform serial 7's d. Have him tell you the days of the week backwards

ANS: D This is a good alternative if the client has never learned to spell. Incorrect answers: 1,2,3. Spelling and use of serial 7's would not be an appropriate alternative with this client's level of formal education.

4. You meet with your clinical instructor and obtain your final grade, a "C." You are disappointed because you expected a "B." Your instructor tells you that you did not always apply theory to practice using the most appropriate reference materials. Which of the following responses represents the ability to accept constructive criticism? a. "I have always been a B student and think I deserve a B" b. "I expected a "B" grade. May we discuss this further at a later time?" c. "Will you review the evaluation form with me?" d. "How would you suggest I improve my clinical research?"

ANS: D This response indicates that the student has listened carefully and has paraphrased the criticism and wants to develop a plan to deal with it. Incorrect answers: 1,2,3. The student has not accepted the constructive criticism or avoided becoming defensive.

8. Mrs. Jones, your elderly client, is visually impaired. You have just completed her care plan. Which of the following interventions is appropriate for Mrs. Jones? a. Stand away from the client when communicating to not obstruct the view of the immediate environment. b. Touch the client to let them know you are there before speaking c. Verbally explain all written information unless the client is wearing her reading glasses d. Verbally describe what is on her meal tray and where each item is located

ANS: D Verbal explanations are important, even if the client does not request help and appears to be looking at her tray Incorrect answers: 1. The nurse should stand in front of the client when speaking. 2. Always identify yourself by name when entering the room. 3. Verbally explain all written information and ask questions to determine level of comprehension.