Correct Answer: B

Rationale: The correct answer is B because Mr. L, who has a tracheostomy and partial laryngectomy, will likely require vital signs monitoring and a detailed client history due to his complex respiratory and communication needs. This assignment will provide the student with valuable experience in caring for clients with specialized needs. Incorrect choices: A: Mr. N (non-Hodgkin lymphoma) - While Mr. N may require vital signs monitoring, his condition does not necessarily involve complex care needs that would warrant a 1-2 hour history-taking session. C: Mr. B (bladder cancer) - Vital signs monitoring and history-taking for a client with bladder cancer may not require as much time as the scenario suggests, as the care needs may not be as complex as those of a client with a tracheostomy and laryngectomy. D: Ms. C (bowel resection and colostomy) - While Ms. C may require vital signs monitoring and history-taking

Correct Answer: D

Rationale: The correct answer is D because appropriate self-disclosure in a therapeutic setting should be brief, focused, and only shared if it enhances the therapeutic relationship. This helps maintain professional boundaries and keeps the focus on the patient's needs. Choice A is incorrect because discussing intimate or personal values with patients can blur boundaries and shift the focus away from the patient. Choice B is incorrect because keeping secrets with or for a patient can lead to ethical dilemmas and compromise trust. Choice C is incorrect because expressing that you are the only one who truly understands the patient can create a power imbalance and hinder the therapeutic process.

Correct Answer: A

Rationale: The correct answer is A: Hemoglobin. Epoetin alfa is a medication that stimulates red blood cell production. Monitoring hemoglobin levels is crucial to assess the effectiveness of the medication. If hemoglobin levels rise too high, it can lead to complications like blood clots. Checking hemoglobin levels helps determine if the dose of epoetin alfa should be adjusted or discontinued. Summary: B: White cell count - Monitoring white cell count is not directly related to epoetin alfa therapy. C: Potassium level - Monitoring potassium level is important for other medications like diuretics or ACE inhibitors, not specifically for epoetin alfa. D: Blood glucose level - Monitoring blood glucose level is important for diabetic patients but not directly related to epoetin alfa therapy.

Correct Answer: D

Rationale: The correct answer is D because addressing an elderly patient as "Sweetie" is inappropriate and unprofessional. It can be perceived as demeaning and disrespectful. The nurse should intervene immediately to address this issue. Choices A, B, and C are all appropriate ways to interact with an elderly patient and promote their well-being. Choice A shows willingness to assist with orientation, choice B offers emotional support through spiritual means, and choice C encourages reminiscence therapy, which can be beneficial for cognitive function.

Correct Answer: D

Rationale: The correct answer is D: a difference in culturally learned personal space of the nurse and the patient. This is because different cultures have varying norms regarding personal space. In this scenario, the Hispanic patient touching the Asian nurse's shoulder and standing very close suggests a cultural difference in personal space expectations. The nurse stepping back to establish a distance of 18 to 24 inches is a respectful response to accommodate the patient's cultural norm. It demonstrates cultural competence and understanding. Explanation for why the other choices are incorrect: A: the nurse's need to maintain a professional role rather than a social role - This choice does not address the cultural aspect of personal space and assumes the nurse's response is solely professional. B: a patient's attempt to keep the nurse's attention - This choice does not consider the cultural factor influencing the patient's behavior. C: a nurse's need to establish a more appropriate location for conversation - This choice does not acknowledge the cultural difference in personal space as the primary reason for the nurse