Nursing Elites

1. A 28-month-old toddler is admitted to the pediatric unit with suspected meningitis. A few hours later the mother tells the nurse, 'I have to leave now, but whenever I try to go, my child gets upset, and then I start to cry.' Which is the best action by the nurse?

• A. Walking the mother to the elevator
• B. Encouraging the mother to spend the night
• C. Staying with the child while the mother leaves
• D. Telling the mother to wait until the child falls asleep

Correct answer: C

Rationale: The best action for the nurse in this situation is to stay with the child while the mother leaves. By doing so, the nurse can provide comfort and reassurance to both the child and the mother. This approach acknowledges the mother's need to leave while ensuring the child is not left alone and is supported during the separation. Walking the mother to the elevator does not address the child's emotional needs and may not provide adequate support. Encouraging the mother to spend the night is not necessary and may not be feasible for her. Telling the mother to wait until the child falls asleep is not recommended as it may create a sense of dishonesty and uncertainty for the child, who should be aware of the mother's departure and reassured that she will return.

2. A client is receiving treatment for delusional behavior. He believes that his neighbor is purposefully poisoning his water system in an attempt to make him sick. Which of the following responses of the nurse is most appropriate?

• A. Did you have the water tested to be sure?
• B. Why do you feel like your neighbor is trying to poison you?
• C. Let's just sit here and watch this television program.
• D. Don't be silly; your neighbor would do no such thing.

Correct answer: B

Rationale: When a client presents with delusional beliefs, the nurse should avoid arguing with the client and should accept the client's initial need to hold onto the delusions. By asking the client 'Why do you feel like your neighbor is trying to poison you?' the nurse encourages the client to express his beliefs further. This open-ended question allows the client to elaborate on his delusions without feeling judged. It helps build trust between the nurse and the client, which is crucial for therapeutic communication. This approach may eventually lead to the client being more receptive to exploring and addressing his delusions. Choices A, C, and D are incorrect. Choice A may come off as dismissive and does not address the client's underlying beliefs. Choice C is a distraction and does not address the client's concerns. Choice D is confrontational and dismissive of the client's beliefs, which can damage the therapeutic relationship.

3. Which basic principle of Alcoholics Anonymous (AA) should a client with alcohol use disorder follow?

• A. Spouses should attend Al-Anon meetings.
• B. It is a commitment to focus on long-term goals.
• C. Amends must be made to each person who has been harmed.
• D. People have the power to overcome alcoholism if they truly want to stop drinking.

Correct answer: C

Rationale: The correct answer is that amends must be made to each person who has been harmed. This principle is reflected in the eighth step of the 12 steps of AA, which involves making a list of all persons harmed and being willing to make amends to them. It is a fundamental principle of AA to address past harms and seek to rectify them. Choice A is incorrect because spouses attending Al-Anon meetings is not a basic principle of AA; it is a support group for family members of individuals with alcohol use disorder. Choice B is incorrect because while focusing on long-term goals can be beneficial, AA emphasizes taking one day at a time rather than committing to long-term goals. Choice D is incorrect because AA teaches that individuals struggling with alcoholism are powerless over their addiction and need to rely on a higher power rather than solely their willpower to overcome it.

4. A 28-year-old woman is recovering from her third consecutive spontaneous abortion in 2 years. Which is the most therapeutic nursing intervention for this client at her follow-up appointment?

• A. Focusing on the client's physical needs
• B. Encouraging the client to verbalize her feelings about the loss
• C. Reminding the client that she will be able to become pregnant again
• D. Encouraging the client to think of herself, her husband, and their future

Correct answer: B

Rationale: The most therapeutic nursing intervention for a client recovering from multiple spontaneous abortions is to encourage the client to verbalize her feelings about the loss. This allows the client to express and process her emotions, facilitating the grieving process and emotional healing. Focusing solely on the client's physical needs, as in choice A, overlooks the importance of addressing the emotional aspect of the client's experience. Choice C, reminding the client that she will be able to become pregnant again, fails to acknowledge the current loss and may minimize the client's feelings of grief. Choice D, encouraging the client to think of herself, her husband, and their future, does not directly address the client's immediate emotional needs related to the recent loss. Therefore, choice B is the most appropriate intervention to support the client in coping with her emotional distress.

5. What factor is likely the reason a woman with bipolar disorder, manic episode, rarely eats?

• A. Feelings of guilt
• B. Need to control others
• C. Desire for punishment
• D. Excessive physical activity

Correct answer: D

Rationale: During a manic episode of bipolar disorder, individuals often experience hyperactivity and an inability to stay still. This hyperactivity can manifest as excessive physical activity, which can prevent them from eating regularly. The correct answer is 'Excessive physical activity' because it directly relates to the woman's lack of appetite during the manic episode. Feelings of guilt, the need to control others, and the desire for punishment are not typically associated with eating difficulties in individuals with bipolar disorder during a manic episode. Clients in a manic episode usually have heightened energy levels and may engage in activities that exhaust them, leading to a decreased focus on eating.

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