Which assessment question regarding a patient's report of pain demonstrates the nurse's attention to the principles of holistic nursing care?

Correct Answer: D

Rationale: The correct answer is D because it addresses the patient's physical, emotional, and social well-being, aligning with holistic nursing care principles. It shows the nurse's consideration of the pain's impact on the patient's daily life. Options A, B, and C focus on specific aspects but do not encompass the holistic approach. Option A focuses only on the pain's timeline, option B on herbal supplements, and option C on familial history, neglecting the patient's overall well-being.

Correct Answer: B

Rationale: The correct answer is B: client preferences. In the EBP model, client preferences play a crucial role in decision-making. When Nurse Sheila adjusts the client's plan of care after talking with them, she is considering the client's individual needs, values, and preferences. This aligns with the client-centered approach of EBP, where decisions are made collaboratively with the client. Incorrect choices: A: Best available research - While research is important in EBP, in this scenario, the focus is on the client's preferences rather than solely relying on research evidence. C: Nursing expertise - While nursing expertise is valuable, in this case, the emphasis is on incorporating the client's input into the plan of care. D: Review of evidence - While reviewing evidence is a component of EBP, in this scenario, the main focus is on the client's preferences rather than the evidence alone.

Correct Answer: D

Rationale: The correct answer is D: Termination phase. In this phase, the goals of therapy have been met, and the client is reflecting on their progress and expressing their feelings about ending therapy. The client's statement about needing to keep coming back indicates that they are aware of the progress made and are preparing to end the therapeutic relationship. A: Pre-interaction phase occurs before the nurse-client relationship is established. B: Orientation phase is when the nurse and client establish rapport and set goals. C: Working phase is when the therapeutic work is being done to achieve goals. Therefore, the client's statement falls in the Termination phase as they are acknowledging the progress made and preparing to end therapy.

Correct Answer: B

Rationale: The correct answer is B because maintaining client confidentiality is a fundamental principle in nursing ethics. By using the client's full name on a submitted record, the student has breached confidentiality. The instructor's priority intervention should be to correct this error and remind the student of the importance of safeguarding client information. Choices A, C, and D are incorrect because they do not address the primary issue of confidentiality breach. Reinforcing accurate documentation (A) is important but secondary to confidentiality. Choice C and D are incorrect as client incompetency or involuntary commitment does not automatically negate the need for confidentiality.

Correct Answer: B

Rationale: The correct answer is B because primary prevention focuses on preventing the development of mental health issues before they occur. Helping school-age children identify and describe normal emotions is an example of primary prevention as it promotes emotional well-being and prevents future mental health problems. Choice A is incorrect because it involves assisting someone who is already diagnosed with a mental illness, which is more of a secondary prevention approach. Choice C involves providing education and support to individuals already in a care home, which falls under secondary prevention. Choice D involves medicating an acutely ill patient, which is more of a tertiary prevention approach aimed at managing existing conditions and preventing further complications.