A nurse is conducting a health assessment for a new client who immigrated from China. The client speaks limited English and has a translator present. Which of the following actions should the nurse take to facilitate effective communication?

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Question 1 of 5

A nurse is conducting a health assessment for a new client who immigrated from China. The client speaks limited English and has a translator present. Which of the following actions should the nurse take to facilitate effective communication?

Correct Answer: A

Rationale: The nurse should use simple words and short sentences when speaking to a client who has limited English proficiency, as this can help to avoid confusion and misunderstanding. The nurse should also speak slowly and clearly, repeat or rephrase information as needed, and ask for feedback to ensure comprehension.

Question 2 of 5

The nurse is charting on the patient who is status post-surgery for an abdominal abscess and notes: "Pt's temperature has not exceeded $37°C this shift." This is an example of a(n)

Correct Answer: B

Rationale: An outcome measures care plan effectiveness (B), like temperature stability post-surgery. An intervention (A) is an action (e.g., administering medication), a plan (C) outlines intended actions, and a diagnosis (D) identifies a problem, none of which fit this evaluative statement, making B correct.

Question 3 of 5

The nurse reviews assessment findings for assigned patients. Based on this information,which patient demands the nurse's immediate attention? The patient with

Correct Answer: B

Rationale: An abdominal aneurysm with hypertension (B) risks rupture, demanding immediate attention. A (normal WBC), C (normal INR), and D (expected murmur) are stable, making B the urgent priority based on assessment data interpretation.

Question 4 of 5

A patient with pneumonia has been using the incentive spirometer four times daily while awake during his 3-day hospitalization. How would the nurse explore the effectiveness of this intervention?

Correct Answer: D

Rationale: Effectiveness is evaluated objectively by auscultating lungs (D) for reduced adventitious sounds, indicating spirometer success. A (subjective), B (new intervention), and C (observation) don’t assess outcomes, making D the best method.

Question 5 of 5

The nurse is listening to a lecture on collaborative problems. Which statement indicates that teaching has been effective?

Correct Answer: C

Rationale: Collaborative problems involve nurse monitoring for complications (C), requiring teamwork with other providers, unlike nursing diagnoses (A). B is false (not two physicians), and D aligns with diagnoses, not collaborative issues, making C correct.

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