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. Which action by a client who requires an above-the-knee amputation for peripheral arterial disease best indicates emotional readiness for the surgery?

• A. Explains the goals of the procedure
• B. Displays few signs of anticipatory grief
• C. Participates in learning perioperative care
• D. Verbalizes acceptance of permanent dependency needs

Correct answer: C

Rationale: Participating actively in learning self-care demonstrates emotional acceptance of the need for surgery and readiness for planning post-surgery. Explaining the goals of the procedure may reflect intellectual readiness but not necessarily emotional readiness. A client who shows few signs of anticipatory grief may be suppressing emotions or in denial, which can hinder the emotional readiness. Verbalizing acceptance of permanent dependency needs suggests the client may require further education and emotional support, as it may not reflect a healthy emotional readiness for the surgery.

3. What psychodynamic process is suggested by a client calling the emergency department during a suicide attempt?

• A. A cry for help
• B. A need for attention
• C. Ambivalence about dying
• D. An inability to stick to a decision

Correct answer: C

Rationale: The correct answer is 'Ambivalence about dying.' When a client calls the emergency department during a suicide attempt, it suggests conflicting feelings about living and dying. This act can indicate an unconscious desire to be stopped from dying, showing ambivalence between the wish to die and the wish to live. It is not primarily a cry for attention or a need to punish others. The client's intention of suicide alongside seeking help demonstrates the struggle between life and death, making ambivalence the key psychodynamic process at play.

4. The nurse is assessing a young client who presents with recurrent gastrointestinal disorders. On further assessment, the nurse learns that the client is experiencing job-related pressures. Which is the most important nursing intervention for this client?

• A. Educate the client on managing stress.
• B. Teach the client to maintain a balanced diet.
• C. Instruct the client to have regular health checkups.
• D. Ask the client to use sunscreen when working outdoors.

Correct answer: A

Rationale: The most important nursing intervention for a client experiencing job-related pressures and recurrent gastrointestinal disorders is to educate the client on managing stress. Stress is a lifestyle risk factor that can impact both mental health and physical well-being. It is associated with various illnesses, including gastrointestinal disorders. Teaching the client to maintain a balanced diet is important for preventive care and health promotion but is not the priority in this scenario. While instructing the client to have regular health checkups is essential for overall health maintenance, addressing the root cause of stress is crucial in this case. Asking the client to use sunscreen when working outdoors is important for sun protection and skin cancer prevention but not directly related to the client's job-related stress and gastrointestinal issues.

5. Which initial response would the nurse make to a 67-year-old man with type 2 diabetes who sadly confides in the nurse that he has been unable to have an erection for several years?

• A. 'At your age, sex isn't that important.''
• B. ''That is a natural occurrence at your age.''
• C. ''You sound upset about not being able to have an erection.''
• D. 'Maybe it's time for you to speak to your primary health care provider about this.''

Correct answer: C

Rationale: The correct response is, 'You sound upset about not being able to have an erection.' When a client discloses personal information, the nurse should respond in a non-judgmental manner to encourage further communication and gather more details. This response demonstrates empathy and understanding, opening the door for the patient to express his feelings and concerns. Choice A, 'At your age, sex isn't that important,' is dismissive and fails to address the client's emotions or concerns, potentially hindering open communication. Choice B, 'That is a natural occurrence at your age,' provides inaccurate information as the inability to have an erection is not considered a normal part of aging. Choice D, 'Maybe it's time for you to speak to your primary health care provider about this,' while important eventually, should not be the initial response as the nurse should first explore the client's feelings and concerns before discussing potential referrals or interventions.

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