Nursing Elites

1. A client is undergoing treatment for alcoholism. Twelve hours after their last drink, they develop tremors, increased heart rate, hallucinations, and seizures. Which stage of withdrawal is this client experiencing?

• A. Stage 1
• B. Stage 2
• C. Stage 3
• D. Stage 4

Correct answer: C

Rationale: In alcohol withdrawal, stage 3 typically begins about 12-48 hours after the last drink. It includes symptoms from stages 1 and 2 like tremors, tachycardia, mild hallucinations, hyperactivity, and confusion. By stage 3, severe hallucinations and seizures can occur. Choice A, stage 1, is too early for the described symptoms. Stage 2, as described, is also too early as it typically occurs within 6-12 hours. Stage 4 is not a recognized stage in alcohol withdrawal protocols.

2. Which of the following examples indicates that the nurse is giving recognition as a form of therapeutic communication?

• A. You need to take your medicine now, Adam.
• B. Jill, your father is trying to make amends with you.
• C. The physician wants to meet with you and your husband, Amy.
• D. Linda, you brushed your hair this morning.

Correct answer: A

Rationale: Recognition is a form of therapeutic communication in which the nurse points out a positive aspect of the client's behavior. Noting that a client brushed her hair herself indicates that the nurse recognizes the client's attempts at self-care. This recognition shows the client that the nurse is paying attention and may be open to further communication. Choices A, B, and C do not demonstrate recognition. Choice A focuses on a directive statement, Choice B involves informing the client about a situation without acknowledging their actions, and Choice C informs the client about a meeting without providing recognition for any behavior.

3. A client who just had a bilateral mastectomy is preparing to talk about body changes. Which of the following actions of the nurse is most appropriate during this discussion?

• A. Provide a room that offers minimal distractions
• B. Ask closed-ended questions to allow the client to think about her situation
• C. Write detailed notes during the conversation to track important information
• D. Ask personal questions about the client's background to determine how the procedure has affected her self-concept

Correct answer: A

Rationale: When preparing to discuss sensitive topics such as body changes post-bilateral mastectomy, it is crucial to create a conducive environment. Providing a room with minimal distractions allows the client to feel comfortable, safe, and more likely to open up about personal feelings without interruptions. This setting fosters open communication between the nurse and client, facilitating a more empathetic and supportive interaction. Closed-ended questions (Choice B) may limit the client's ability to express emotions fully. Writing detailed notes (Choice C) during the conversation may distract the nurse from actively listening and being present for the client. Asking personal questions about the client's background (Choice D) may not be appropriate during such a vulnerable discussion and could potentially create discomfort for the client.

4. A child is undergoing chemotherapy to treat a neuroblastoma, stage IV, and had his first chemotherapy session last week. He arrives with his mother for this week's session. How would the nurse greet the child?

• A. How did you feel after your last treatment?
• B. What are your thoughts on the treatment so far?
• C. Did you experience any side effects after the last session?
• D. Are you ready for the next round of treatment?

Correct answer: A

Rationale: The most appropriate way for the nurse to greet the child is by asking, 'How did you feel after your last treatment?' This question allows the child to share their experience voluntarily, empowering them to feel in control of the conversation. It also demonstrates empathy and a caring attitude. Option B, 'What are your thoughts on the treatment so far?' is broad and may not address the child's immediate feelings after the last session. Option C, 'Did you experience any side effects after the last session?' focuses solely on side effects and may predispose the child to think negatively. Option D, 'Are you ready for the next round of treatment?' does not address the child's current well-being or feelings, missing an opportunity for emotional support and connection.

5. The mental health nurse plans to discuss a client's depression with the health care provider in the emergency department. There are two clients sitting across from the emergency department desk. Which nursing action is best?

• A. Only refer to the client by gender
• B. Identify the client only by age
• C. Avoid using the client's name
• D. Discuss the client another time

Correct answer: D

Rationale: The best nursing action is to discuss the client another time to ensure confidentiality. It is important to maintain the privacy of the client's information, so discussing sensitive topics like depression in a public area where conversations can be overheard is not appropriate. While options A, B, and C may seem like ways to protect the client's identity, they do not guarantee confidentiality since details like gender or age can still lead to identification. Therefore, the nurse should prioritize privacy and confidentiality by finding a more suitable time and location to have a private discussion about the client's concerns.

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