Nursing Elites

1. A client says, 'The doctors lied about me. They said I murdered my mother. You killed her. She died before I was born.' Which psychotic feature is the client experiencing?

• A. Ideas of grandeur
• B. Confusing illusions
• C. Persecutory delusions
• D. Auditory hallucinations

Correct answer: C

Rationale: The client is experiencing persecutory delusions, as she believes that others are blaming her for negative actions. This is not about ideas of grandeur, which involve feelings of greatness or power. Confusing illusions refer to misinterpretation of stimuli, which is not present in this scenario. Auditory hallucinations involve hearing voices, which is not the case here. In this case, the client is delusional, but not hallucinating.

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. A client with invasive carcinoma of the bladder is scheduled for a cystectomy and an ileal conduit. The client expresses worries about the possibility of offensive odors associated with the urinary diversion. How would the nurse respond?

• A. ''Tell me more about your concerns.''
• B. ''Products are available to address this issue.''
• C. ''This is a valid concern, and we can discuss ways to manage it.''
• D. ''Many individuals who undergo this procedure have similar worries.''

Correct answer: A

Rationale: The response ''Tell me more about your concerns'' is open-ended, encouraging the client to express their worries freely. This approach fosters communication and shows empathy. Option B acknowledges the concern and offers a solution, demonstrating support and understanding. Option C validates the client's worry and suggests collaboration in finding solutions. Option D normalizes the concern but may not address the client's specific worries, making it less therapeutic than the other options. Overall, actively listening to the client's concerns and offering support are essential in providing holistic care.

4. Which response would the nurse make to a client with borderline personality disorder who receives the wrong tray for lunch and becomes upset at the dietary staff regarding this mistake?

• A. 'Getting angry is not appropriate; let's address this calmly.''
• B. ''Yelling is not acceptable and won't help us resolve this issue.''
• C. 'You must eat the first tray of food, and then I'll get another tray for you.''
• D. 'It must be frustrating to get the wrong tray. I'll order another tray for you.''

Correct answer: D

Rationale: The most appropriate response from the nurse would be, ''It must be frustrating to get the wrong tray. I'll order another tray for you.'' When interacting with clients with borderline personality disorder, it is crucial for nurses to acknowledge the client's emotions empathetically and provide constructive solutions. While expressing anger is understandable, guiding the client towards a more constructive approach is essential. Yelling is not a helpful way to address the situation and threatening seclusion is inappropriate. Additionally, instructing the client to eat the first tray before receiving another one is punitive and disregards the client's preferences and rights.

5. The client believes that the illness is a punishment for sins. Which cultural health belief is the client communicating?

• A. Yin/Yang balance
• B. Biomedical belief
• C. Determinism belief
• D. Magicoreligious belief

Correct answer: D

Rationale: The client is communicating a magicoreligious belief by attributing the illness to punishment for sins. In this belief system, illness is seen as caused by supernatural forces or hexes, often related to spiritual or religious beliefs. The yin/yang balance belief system does not view illness as punishment but rather as an imbalance of opposing forces. Biomedical belief focuses on physical and biochemical processes as the cause of health and illness. Determinism belief revolves around outcomes being preordained and unchangeable, not related to punishment for sins.

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