The nurse cares for a client with abdominal pain who is scheduled for exploratory surgery. Which statement(s), if made by the nurse, indicates that the client's rights in the helping relationship have been violated? (Select all that apply)

Correct Answer: A

Rationale: The correct answer is A because it indicates a violation of the client's rights in the helping relationship. By stating "I do not have time right now to help you call your family," the nurse is disregarding the client's need for support and communication with their family, which is a fundamental aspect of patient rights. This response demonstrates a lack of empathy and neglect of the client's emotional needs during a vulnerable time. Explanation of why other choices are incorrect: B: "I am available to answer questions that you may have about your surgery." - This choice demonstrates the nurse's willingness to provide information and support, which aligns with the client's rights. C: "You seem frightened. I will stay with you until your family arrives." - This choice shows the nurse's empathy and commitment to the client's emotional well-being, respecting the client's rights. D: "Your neighbors called, and I told them that you will have surgery." - This choice shows the nurse's communication with others

Correct Answer: B

Rationale: Step 1: Asking the client to report the amount of fluid intake for the past 24 hours is the most appropriate action because it provides objective data on the client's adherence to fluid restrictions. Step 2: This information helps the nurse to assess the client's compliance and make informed decisions about the next steps in care. Step 3: By obtaining accurate information on fluid intake, the nurse can identify any discrepancies between prescribed fluid restrictions and actual intake, leading to appropriate interventions. Step 4: This action promotes client accountability and empowers them to take an active role in managing their health. In summary, choice B is correct as it directly addresses the issue of non-adherence to fluid restrictions by gathering crucial information for assessment and intervention. Choices A, C, and D do not provide immediate actionable data on the client's fluid intake and do not address the core issue effectively.

Correct Answer: C

Rationale: The correct answer is C. By saying, "We can come back to that later—right now I need to know about when your symptoms started," the nurse is refocusing the patient to the issue at hand when the conversation has wandered. This response helps maintain the focus of the conversation on gathering important information about the patient's symptoms, which is crucial for providing appropriate care. It acknowledges the patient's concerns while redirecting the conversation back to the main topic. Choices A, B, and D are incorrect because they do not accurately reflect the nurse's intention in the given statement. Choice A implies judgment on the patient's conversation topic, choice B suggests limiting the patient's emotional expression, and choice D implies a rushed or dismissive attitude towards the conversation, none of which are demonstrated by the nurse's response.

Correct Answer: D

Rationale: The correct answer is D because informing the patient about a medication error and symptoms to report demonstrates transparency, honesty, and prioritizing the patient's safety and well-being. It shows genuine concern by ensuring the patient is informed and involved in their care. Choice A is incorrect as it provides false reassurance. Choice B is incorrect as delaying notification can harm the patient emotionally and undermine trust. Choice C is incorrect as it involves deception and risks the patient's well-being for assessment purposes.

Correct Answer: C

Rationale: The correct answer is C: 3 days. After BCG treatment for bladder cancer, it is crucial for the healthcare provider (HCP) to be notified if a normal voiding pattern does not resume within 3 days. This timeframe allows for monitoring any potential complications or urinary retention post-catheter removal. Option A (6 hours) is too short for significant changes to occur, option B (12 hours) is also too soon to assess the situation comprehensively, and option D (1 week) is too long to wait for potential issues to be addressed promptly. Therefore, option C is the most appropriate time frame for early intervention if the patient experiences any urinary difficulties post-catheter removal.

Correct Answer: B

Rationale: The correct answer is B: Collaboration. Mutuality in the nurse-client relationship involves working together towards shared goals, with both parties actively participating and contributing to decision-making processes. Collaboration fosters a relationship based on equality, respect, and shared responsibility, leading to improved outcomes for the client. A: Dependency is not a characteristic of mutuality as it implies one party relying solely on the other, which goes against the principles of collaboration and shared decision-making. C: Paternalism is not a characteristic of mutuality as it involves a one-sided approach where the nurse makes decisions on behalf of the client without their active involvement or input. D: Acceptance of differences, while important in promoting understanding and respect in the relationship, is not a defining characteristic of mutuality. It is more about acknowledging and respecting each other's unique perspectives rather than actively collaborating towards common goals.

Correct Answer: A

Rationale: Rationale: - Choice A is correct because it is nonassertive and implies a desire for control over others' schedules, which may frustrate the nurse manager. - Choice B is incorrect because it shows indifference, not assertiveness. - Choice C is incorrect as it expresses a clear preference without being nonassertive. - Choice D is incorrect because it is assertive but in a negative and confrontational way.

Correct Answer: B

Rationale: The correct answer is B: Assertive, responsible, and caring communication. This approach is effective because it involves setting clear boundaries (assertive), taking ownership of the situation (responsible), and showing empathy and support (caring). By being assertive, the nurse can communicate expectations clearly. Being responsible conveys accountability and encourages the patient to take ownership of their health. The caring aspect fosters a supportive environment, making the patient feel understood and motivated to change. Choice A (Authoritative, honest, and outright communication) may come off as too forceful and may not promote cooperation. Choice C (Aggressive, sympathetic, and realistic communication) is contradictory - being aggressive does not align with being sympathetic. Choice D (Positive, expert, and focused communication) lacks the element of assertiveness needed to set clear boundaries and expectations.

Correct Answer: B

Rationale: The correct answer is B because conducting a cultural assessment allows the nurse to understand the client's unique health beliefs and behaviors. This helps in providing culturally sensitive care and promoting effective communication. Choice A is incorrect as it focuses on generalizing health beliefs of a population without considering individual variations. Choice C is incorrect as it does not directly address the client's specific needs. Choice D is incorrect because standard communication techniques may not be culturally appropriate or effective in this situation. Conducting a cultural assessment is essential for providing client-centered care.