Nclex Questions Management of Care - Nurselytic

Correct Answer: B

Rationale: The correct answer is B. Incident reports play a crucial role in risk management by providing data for analysis to prevent future problems. They are not primarily for liability protection (
A) or disciplining staff (
C).
Therefore, choice B is the most appropriate answer. Choosing option D is incorrect because incident reports do not solely exist for all the mentioned purposes, but primarily to provide data for analysis and preventive actions.

Correct Answer: D

Rationale: The correct answer is to attend to the care needs of the returning postoperative client just exiting the elevator first. In a healthcare setting, patient care should always take precedence, especially for complex or unstable clients requiring immediate assessment and care. The physician's loud verbal direction, the nursing supervisor going to a meeting, and unit staff leaving on a break are important but do not involve direct patient care.
Therefore, the nurse should prioritize responding to the returning postoperative client to ensure their immediate needs are met.

Correct Answer: A

Rationale: The correct answer is 'grief work facilitation' because it is a nursing intervention classification specifically designed to address disturbed body image in burn clients. The expected outcome of this intervention is grief resolution, which can help the client cope with the body image changes resulting from the burn.

Choice B, 'vital signs monitoring,' is not the appropriate intervention for body image disturbance in burn clients. Vital signs monitoring is typically used for assessing physiological parameters like blood pressure, pulse rate, and temperature.

Choice C, 'medication administration: skin,' is more focused on treating skin-related issues rather than addressing body image disturbance. It involves the administration of medications to promote skin healing and integrity.

Choice D, 'anxiety reduction,' is aimed at managing anxiety in clients with major burns and is not specifically targeted at addressing body image disturbance. While anxiety may be a common emotional response to burns, the most appropriate intervention for body image disturbance in this scenario is 'grief work facilitation.'

Correct Answer: A

Rationale:
To protect the privacy of clients and the confidentiality of the information shared in a change-of-shift report, the family should be asked to wait in the client's room. This ensures that sensitive information is not overheard. The report should be resumed only after the family has left the desk area to maintain confidentiality.
Choice B is incorrect as bringing coffee does not address the issue of maintaining confidentiality.
Choice C is incorrect as standing or sitting in the station does not prevent the family from overhearing confidential information.
Choice D is incorrect as the Emergency Department waiting room is not the appropriate setting for waiting during a unit admission.

Correct Answer: C

Rationale: Genital herpes can be transmitted through oral, genital, and anal sex. It is crucial to educate the patient that the infection can be transmitted via intercourse even when asymptomatic to prevent its spread.
Choice A is incorrect as sitting on toilet seats without protection does not transmit genital herpes.
Choice B is incorrect because oral sex can transmit the virus.
Choice D is also incorrect as drinking fluids after sex does not prevent the transmission of genital herpes.