The nurse is about to begin working with a client diagnosed with a sexual disorder. During the preinteraction phase of the nurse–patient relationship, it is important for the nurse to:
1. Discuss the nurse's beliefs with the client.
2. Agree with the client's sexual values.
3. Engage in values clarification.
4. Provide appropriate sexual health care.
3
Rationale: As part of self-awareness, the nurse would engage in values clarification. During the preinteraction phase, the nurse would not provide sexual health care. It is inappropriate for the nurse to agree or disagree with the client's sexual values or to discuss the nurse's beliefs with the client.
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The nurse has found the patient with delirium in other patients' rooms several times. The best action by the nurse would be to:
1. firmly tell the patient that he must stay out of other patients' rooms and tell him to return to his room. 2. take him back to his room and put him in bed with the side rails up. 3. take him to the nurses' station and let him "visit" for a while. 4. administer a dose of Ativan (lorazepam) as ordered.
A client is scheduled to have a suspected cancerous lesion removed from the scalp. When planning care for this client, the nurse expects which of the following priority outcomes for this client?
1. The client will heal without signs of infection. 2. The client will experience some pain after healing. 3. The client will not need to make lifestyle changes. 4. The client will make nutritional changes.
Shearing is
A. scrubbing the skin with an abrasive cloth, substance, or chemical. B. sliding a patient from the bed to the chair with adaptive equipment. C. dragging the heels across the bed surface when moving with a lifting sheet. D. stretching the skin in one direction while the bone moves in the opposite direction.
Which of the following buffer pairs is considered the major plasma buffering system?
a. Protein/fat b. Carbonic acid/bicarbonate c. Sodium/potassium d. Amylase/albumin