Nursing Elites

1. A client in the cardiac step-down unit requires suctioning for excess mucous secretions. The nurse should be most careful to monitor the client for which dysrhythmia during this procedure?

• A. Bradycardia
• B. Tachycardia
• C. Premature ventricular beats
• D. Heart block

Correct answer: A

Rationale: During suctioning, a vagal response can be triggered leading to bradycardia. It is crucial for the nurse to monitor for this potential dysrhythmia. Tachycardia (Choice B) is less likely during suctioning and is not the priority. Premature ventricular beats (Choice C) and heart block (Choice D) can occur but are less common compared to bradycardia in this situation.

2. The nurse is assessing an elder whom the nurse suspects is being physically abused. The most important question for the nurse to ask is:

• A. "How much money do you keep around the house?"?
• B. "Who provides your physical care?"?
• C. "How close does your nearest relative live?"?
• D. "What form of transportation do you use?"?

Correct answer: B

Rationale: The most important question for the nurse to ask when suspecting elder abuse is 'Who provides your physical care?' This question is crucial as the primary caregiver, who is often the abuser in cases of elder abuse, lives with the client. Research has shown that spouses and adult children are the most common abusers. By inquiring about the provider of physical care, the nurse can assess the potential abuser's proximity to the elder. Choices A, C, and D are less pertinent to identifying the primary caregiver, who is more likely to be the abuser.

3. When medications have an additive, synergistic, or antagonistic effect on a tissue, a ________ reaction has occurred.

• A. pharmaceutical
• B. pharmacodynamic
• C. pharmacokinetic
• D. drug incompatibility

Correct answer: B

Rationale: The correct answer is 'pharmacodynamic.' Pharmacodynamics pertain to the effect of a drug on receptors, explaining how drugs affect tissues. Pharmaceutical reactions refer to chemical reactions between drugs before administration or absorption, not their effect on tissues. Pharmacokinetic reactions involve how the body affects the drug, not the tissue. Drug incompatibilities are essentially pharmaceutical reactions, not the specific effects on tissues seen in pharmacodynamic reactions.

4. What can the nurse instruct the mother of a teething 9-month-old infant to relieve discomfort?

• A. Rub the infant's gums with baby aspirin dissolved in water.
• B. Obtain an over-the-counter (OTC) topical medication for gum pain relief.
• C. Schedule an appointment with a dentist for a dental evaluation.
• D. Give the infant cool liquids or a Popsicle and hard foods such as dry toast.

Correct answer: D

Rationale: Teething in infants can cause discomfort, but it is a normal process. Symptoms may include nighttime awakening, daytime restlessness, excess drooling, and temporary loss of appetite. The recommended approach to relieve teething discomfort includes providing cool liquids, a Popsicle, or hard foods like dry toast for chewing. These items can help soothe the infant's gums. Rubbing the gums with baby aspirin dissolved in water is not recommended as it can be harmful. OTC topical medications are unnecessary for teething discomfort. Scheduling a dental evaluation is not required solely for teething. It's important to avoid home remedies like baby aspirin and opt for safer options like cool liquids. If necessary, acetaminophen (Tylenol) can be used under healthcare provider guidance to alleviate discomfort.

5. Two staff nurses were considered for promotion to head nurse. The promotion is announced via a memo on the unit bulletin board. The nurse who was not promoted tells a friend, "Oh, well, I really didn't want the job anyway."? This is an example of:

• A. rationalization.
• B. denial.
• C. projection.
• D. compensation.

Correct answer: A.

Rationale: This is an example of rationalization, specifically the sour grapes form, where the individual convinces themselves that they didn't want something after realizing they couldn't have it. Rationalization is an unconscious form of self-deception involving making excuses. In this scenario, the nurse is rationalizing her disappointment by downplaying her desire for the promotion. Denial involves ignoring the existence of a situation, which is not demonstrated here. Projection involves blaming others unconsciously, which is also not present in this situation. Compensation is an attempt to offset a perceived weakness by emphasizing a strong point, which is not shown in the nurse's response.

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