EAQ #3 Patient Centered Care

While teaching parents about the developmental milestones of a 15-month-old child, the nurse informs the parents about various activities that their child should be able to do. Which statement of the parent indicates effective learning?

1: "My child can creep up stairs and kneel without support." A 15-month-old child has the ability to creep up stairs and kneel without support because of the development of gross motor skills. The child starts jumping with both feet at the age of 30 months. The child will start walking up stairs with one hand held at the age of 18 months. The calf muscles develop sufficiently for the child to walk up and down stairs alone at the age of 24 months.

A child is frightened and refuses to use the toilet after watching a television commercial that shows the toilet bowl turning into a monster and swallowing the person using it. Which behavior does the child exhibit?

1: Animism Relating lifelike qualities to nonliving things is called animism. Therefore, when a child believes that the toilet bowl turns into a monster and swallows a person, he or she exhibits animism. Aggression is characterized by an attempt to hurt a person or damage property. Modeling is associated with imitation of others' behavior. Desensitization is a therapeutic technique that involves exposing the child to the feared object in a safe situation. Test-Taking Tip: Look for answers that focus on the client or are directed toward feelings.

What does a nurse do during the orientation phase of a helping relationship?

1: The nurse develops a healthy relationship with the client.

The nurse explains the purpose of a nonstress test to a pregnant client who is at 39 weeks' gestation. This test is a way of evaluating the condition of the fetus by comparing the fetal heart rate with what?

2: Fetal movement In a healthy, well-oxygenated fetus the heart rate increases with fetal movement; there should be an acceleration of 15 beats with fetal movement. Fetal lie and maternal blood pressure are not a part of the evaluation of the fetus in the nonstress test. Maternal uterine contractions are used in the contraction stress test.

A client is scheduled for several diagnostic studies. Which behavior best indicates to the nurse that the client has received adequate preparation?

3: Arrives early and waits quietly to be called for the tests. The client's early arrival indicates an expected degree of anxiety; the quiet waiting indicates that the client has been told what to expect. A request for the tests to be explained again indicates an inadequate explanation or the inability of the client to remember the explanation that has been given. Checking the appointment card repeatedly and pacing up and down the hallway on the morning of the tests indicate a high degree of anxiety that may denote a fear of the tests because they have not been adequately explained.

After reviewing the urinalysis reports of a group of clients, a nurse suspects a client to have kidney disease. Which client's findings support the nurse's suspicion?

3: Client C (Serum Creatinine: 2.5 mg/dL) The normal range of serum creatinine lies between 0.6 and 1.2 mg/dL. The serum creatinine concentration of client C is 2.5 mg/dL, which is greater than the normal value, and indicates renal impairment. Therefore the laboratory findings of client C support the nurse's suspicion. A serum creatinine concentration of 1.1 mg/dL in client A is a normal finding. The normal range of blood urea nitrogen (BUN) is 10 to 20 mg/dL; therefore, the urinalysis reports for clients B and D are normal.

The nurse in the postpartum unit is teaching self-care to a group of new mothers. What color does the nurse teach them that the lochial discharge will be on the fourth postpartum day?

3: Pinkish brown Lochia serosa is the expected vaginal discharge between the third and tenth postpartum days; it is pinkish to brownish and consists of serous exudate, shreds of degenerating decidua, erythrocytes, leukocytes, cervical mucus, and numerous microorganisms. Lochia rubra is the expected vaginal discharge on the first 2 or 3 postpartum days; it is dark red and consists of epithelial cells, erythrocytes, leukocytes, shreds of decidua, and occasionally fetal meconium, lanugo, and vernix caseosa. Lochia is never dark brown. Lochia alba is the expected vaginal discharge about 10 days postpartum; it persists for 1 to 2 weeks. A creamy or yellowish color, it consists of leukocytes, decidual cells, epithelial cells, fat, cervical mucus, cholesterol crystals, and bacteria.

Immediately after birth, a newborn is dried before being placed in skin-to-skin contact with the mother. What type of heat loss does this intervention prevent?

4: Evaporation Evaporative heat loss is a result of the conversion of moisture into vapor, which is avoided when the newborn is dried. Radiation is the loss of heat to colder solid surfaces that are not in direct contact. Convective heat loss is a result of contact of the exposed skin with cooler surrounding air currents. Conductive heat loss is a result of direct skin contact with a cold solid object.

A nurse is caring for a client who developed aseptic necrosis after a fracture of the head of the femur. The nurse prepares to administer care based on which factor?

4: Loss of blood supply to the head of the femur. After a fracture, if blood supply is cut off or impaired, necrosis of the bone may occur from lack of oxygen and nutrient perfusion. The word aseptic indicates that infection is not present. Early weight-bearing at the fracture site may result in trauma to the bone; circulation is not impaired. Immobilization does not cut off circulation to the bone; it may cause contractures. Test-Taking Tip: After you have eliminated one or more choices, you may discover that two of the options are very similar. This can be very helpful, because it may mean that one of these look-alike answers is the best choice and the other is a very good distractor. Test both of these options against the stem. Ask yourself which one completes the incomplete statement grammatically and which one answers the question more fully and completely. The option that best completes or answers the stem is the one you should choose. Here, too, pause for a few seconds, give your brain time to reflect, and recall may occur.

A toddler wearing a diaper is impatient with the wet diaper and a shows a desire to have it changed. Which toilet training readiness does this behavior indicate?

4: Psychological readiness The toddler's impatience with the wet diaper and desire for a change indicates psychological readiness for toilet training. Mental readiness is indicated when the toddler recognizes the urge to urinate. Physical readiness is indicated when the toddler is voluntarily able to control the sphincter and wakes up dry after a nap. Parental readiness is indicated when the parent is willing to invest the time required for toilet training.