Nursing Elites

1. A client in a long-term care facility reports to the nurse that he has not had a bowel movement in 2 days. Which intervention should the nurse implement first?

• A. Instruct the caregiver to offer a glass of warm prune juice at mealtimes.
• B. Notify the healthcare provider and request a prescription for a large-volume enema.
• C. Assess the client's medical record to determine the client's normal bowel pattern.
• D. Instruct the caregiver to increase the client's fluids to five 8-ounce glasses per day.

Correct answer: C

Rationale: The first step in addressing a client's reported change in bowel habits is to assess the client's normal bowel pattern. This assessment helps the nurse understand the client's typical bowel habits and identify any deviations from the norm. By assessing the medical record first, the nurse gains valuable information that guides further interventions. In this scenario, offering prune juice (Option A) or increasing fluids (Option D) may not be appropriate until the client's normal bowel pattern is known. Notifying the healthcare provider for a large-volume enema (Option B) is premature without understanding the client's baseline. Therefore, assessing the client's medical record is the priority before proceeding with any interventions.

2. A client who exhibits blurred and double vision and muscular weakness is informed of the diagnosis of multiple sclerosis (MS). The client becomes visibly upset. Which response would the nurse make?

• A. That must have shocked you. Tell me what the health care provider told you about it.
• B. You should see a psychiatrist who will help you cope with this overwhelming news.
• C. Don't worry; early treatment often alleviates the symptoms of the disease.
• D. You should be glad that we caught it early so you can be cured.

Correct answer: A

Rationale: The response 'That must have shocked you. Tell me what the health care provider told you about it' acknowledges the effect of the diagnosis on the client and explores what is known. This response shows empathy and encourages the client to share their understanding. There is no evidence of ineffective coping, so a referral to a psychiatrist is not necessary at this initial stage. The statement 'Don't worry; early treatment often alleviates symptoms of the disease' provides false reassurance as the course of MS varies for each individual and may not always respond well to treatment. The statement 'You should be glad we caught it early so it can be cured' does not address the client's current emotional state and is inaccurate; MS is a chronic autoimmune disease that currently has no cure.

3. How is the secondary use of data from the 2000 census classification system utilized to address disparities in mental health care along racial-ethnic lines?

• A. To provide culturally relevant care to the required ethnic group
• B. To identify all racial and ethnic groups in the United States
• C. To identify why there are disparities in the United States
• D. To determine when and how the health care needs of the ethnic populations are being met

Correct answer: D

Rationale: The census classification system categorizes individuals based on racial and ethnic descriptions. Utilizing this data helps in identifying health disparities and assessing how the health care needs of ethnic populations are being addressed. Option A is incorrect because the primary focus is on analyzing healthcare needs met, not providing care. Option B is incorrect as the census does not encompass every single racial and ethnic group in the United States. Option C is incorrect as the census is not designed to investigate the reasons behind disparities, but rather to quantify and analyze them.

4. A client at a local university claims to be the president of the university. Which type of delusion is the client displaying?

• A. Somatic
• B. Grandiose
• C. Erotomanic
• D. Persecutory

Correct answer: B

Rationale: The correct answer is 'Grandiose.' This type of delusion involves an exaggerated sense of self-importance, where the individual believes they are a prominent figure or possess special abilities. In this scenario, the client claiming to be the president of the university is displaying grandiose delusions. Somatic delusions relate to bodily functions or sensations, which are not present in this case. Erotomanic delusions involve the fixed belief that another person is in love with the individual, which is not applicable here. Persecutory delusions involve the belief that one is being targeted or conspired against, which is also not demonstrated in the given situation.

5. Which instruction should the nurse provide to a preschool-age client to prevent altered growth and development?

• A. Trust
• B. Empathy
• C. Impulse control
• D. Problem-solving

Correct answer: C

Rationale: Teaching a preschool-age child and their parents about the importance of impulse control is essential to prevent the risk of altered growth and development. Preschool-age children are at a stage where they are developing self-regulation skills, so teaching them to manage their impulses can help in their overall growth and development. Trust is a critical concept taught during infancy to foster secure attachments. Empathy is crucial for parents of toddlers to understand their child's emotions. Problem-solving skills are typically emphasized for school-age children to enhance cognitive development.

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