Nursing Elites

1. A client states that she is angry and feels rejected by her boyfriend. Which action would the nurse encourage?

• A. Call the boyfriend to work things out.
• B. Avoid confronting the boyfriend.
• C. Date new people whenever possible.
• D. Learn to constructively vent anger.

Correct answer: D

Rationale: The correct answer is to encourage the client to learn to constructively vent anger. Coping mechanisms, such as venting anger, can help the client address feelings of rejection. Calling the boyfriend to work things out is offering unsolicited advice and may not be effective in managing emotions. Avoiding confronting the boyfriend may reduce anxiety temporarily but will not assist in resolving the underlying issues. Encouraging the client to date new people whenever possible is not appropriate at this stage, as it is essential for the client to work through the current crisis before considering new relationships.

2. A client who is at 28 weeks' gestation and in active labor is crying. She says, 'I just know that this baby is going to die. What's the use of doing all this to save it?' Which explanation would interpret the client's statements?

• A. She is depressed and needs gentle, positive support during labor.
• B. She is experiencing anticipatory grief and withdrawing from bonding.
• C. She is in need of emotional support to help her cope with the impending birth.
• D. She is struggling to cope with the birth by using the word 'it.'

Correct answer: B

Rationale: The client's statement indicates anticipatory grief, where she is preparing for a potential loss. This grief is not necessarily about the literal death of the baby but about the loss of the anticipated healthy full-term baby. The client may not be ready to bond with the reality of a preterm baby. Providing gentle, positive support is essential to help her cope with her feelings, as firm support may come across as dismissive. Sedation is not appropriate as it could hinder the client's emotional processing. Allowing the client to express her emotions and work through anticipatory grieving is crucial. The use of the word 'it' reflects the client's emotional struggle and is not the primary issue at hand.

3. Jerry is a 55-year-old veteran who has been admitted after a motor vehicle accident with multiple injuries. His friend reported that he had been using synthetic marijuana prior to the accident, and that he also sees a psychiatrist at the VA hospital for an unknown diagnosis. He stated that Jerry sometimes gets "hyper"? for no reason, starts "ranting"? and becomes violent. Of the following, which general psychiatric disorder is characterized by a pattern of aggression or violence that includes irritability, agitation, and violent behavior during manic or psychotic episodes?

• A. Schizophrenia
• B. Post-traumatic stress disorder (PTSD)
• C. Bipolar disorder
• D. Delusional disorder

Correct answer: C

Rationale: Bipolar disorder is characterized by a pattern of aggression or violence that includes irritability, agitation, and violent behavior during manic or psychotic episodes. This disorder is highly co-morbid with substance use, which can worsen the prognosis. While schizophrenia may involve aggression, it is not typically associated with mood episodes like mania that characterize bipolar disorder. Post-traumatic stress disorder (PTSD) is primarily characterized by re-experiencing traumatic events, avoidance behaviors, and hyperarousal, but not the distinct mood episodes seen in bipolar disorder. Delusional disorder is characterized by fixed false beliefs without the mood changes seen in bipolar disorder. Therefore, the correct answer is Bipolar disorder.

4. The nurse notes bruises on the pregnant client's face and abdomen. There are no bruises on her legs and arms. Further assessment is required to confirm which condition?

• A. Domestic abuse
• B. Hydatidiform mole
• C. Excessive exercise
• D. Thrombocytopenic purpura

Correct answer: A

Rationale: Domestic abuse is a serious concern during pregnancy as it can escalate, and the bruises on the face and abdomen may indicate physical violence towards the pregnant woman. Hydatidiform mole presents with symptoms like an enlarged uterus for gestational age, hypertension, nausea, vomiting, and vaginal bleeding, not bruises. Excessive exercise typically leads to cardiovascular or pulmonary issues, not bruising. Thrombocytopenic purpura and other bleeding disorders usually present with bruises and petechiae on various body surfaces, not just limited to the face and abdomen.

5. A staff nurse expresses frustration that a Native American patient always has several family members at the bedside. Which action by the charge nurse is most appropriate?

• A. Remind the nurse that family support is important to this family and patient.
• B. Have the nurse explain to the family that too many visitors will tire the patient.
• C. Suggest that the nurse ask family members to leave the room during patient care.
• D. Ask about the nurse's personal beliefs about family support during hospitalization.

Correct answer: D

Rationale: The first step in providing culturally competent care is to understand one's own beliefs and values related to health and health care. Asking the nurse about personal beliefs will help achieve this step. Reminding the nurse that this cultural practice is important to the family and patient will not decrease the nurse's frustration. The remaining responses, such as suggesting that the nurse ask family members to leave the room or having the nurse explain to the family that too many visitors will tire the patient, are not culturally appropriate for this patient.

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