Nursing Elites

1. A client who has multiple sclerosis is admitted to the hospital with increasingly frequent and severe exacerbations. One day, the client's partner confides to the nurse, 'Life is getting very hard and depressing, and I am upset with myself for thinking about a nursing home.' After listening to the partner's concerns, which response would the nurse make?

• A. 'Joining a support group of people who are coping with this situation may be helpful.'
• B. 'You may be able to decrease your feelings of guilt by seeking counseling.'
• C. 'It would be helpful if you became involved in volunteer work at this time.'
• D. 'I recognize it's hard to deal with, but try to remember that this, too, shall pass.'

Correct answer: A

Rationale: Joining a support group of individuals facing similar circumstances can provide valuable support and the opportunity to share experiences, making it the most appropriate response. The response suggesting counseling to decrease feelings of guilt is premature because the partner did not directly express guilt and it may not be the most immediate need. Suggesting involvement in volunteer work at this time fails to address the partner's current emotional distress and may come across as dismissive. Offering false reassurance by stating 'this, too, shall pass' does not validate the partner's feelings and minimizes the seriousness of their concerns.

2. A client undergoing presurgical testing before a total abdominal hysterectomy says to the nurse, 'After I have this surgery I know my husband will never come near me again.' Which response would the nurse give?

• A. You're underestimating how your husband will respond to your surgery.
• B. You're concerned about the effect on your sexual relations.
• C. You're worried that the surgery will change how others see you.
• D. You're concerned about how your husband will respond to your surgery.

Correct answer: D

Rationale: The correct response acknowledges the client's expressed concern about her husband's reaction to the surgery, encouraging further discussion without imposing the nurse's assumptions. Choice A reframes the client's concern to focus on the husband's response, aligning more closely with the client's stated worry. Choice B makes an assumption about the client's concerns regarding sexual relations, which may not be the primary focus of her statement. Choice C shifts the attention to how others perceive the client, deviating from the client's specific reference to her husband's reaction, thus not addressing the client's main concern.

3. According to psychodynamic theory, what purpose do delusions serve?

• A. Delusions are a defense against anxiety caused by real or imagined threats.
• B. Magical thinking is a delusion that ensures desirable outcomes.
• C. Delusions are a method of dealing with and interpreting external stimuli.
• D. Subconsciously, delusions are a way to safely express anger and hostility.

Correct answer: A

Rationale: According to psychodynamic theory, delusions serve as a defense mechanism against anxiety triggered by real or perceived threats. Delusions are the individual's unconscious way of protecting themselves from overwhelming feelings of anxiety. Magical thinking, on the other hand, involves believing that one's thoughts can influence external events. This is not the same as delusions. Delusions are not a way of interpreting external stimuli but rather a defense mechanism. Expressing anger and hostility is typically associated with defense mechanisms like displacement or projection, not delusions.

4. Which approach is best to use with a client who is angry and agitated?

• A. Confront the client about the behavior.
• B. Turn on the television to distract the client.
• C. Maintain a calm, consistent approach with the client.
• D. Explain to the client why the behavior is unacceptable.

Correct answer: C

Rationale: When dealing with an angry and agitated client, it is crucial to maintain a calm and consistent approach. Consistency allows the client to predict the caregiver's behavior, which can help reduce their anxiety and agitation. Confronting the client about their behavior may escalate the situation and increase their anger. Using distractions like turning on the television is not addressing the underlying issue and may not be effective in calming the client. Explaining to the client why their behavior is unacceptable is not suitable in the moment of agitation, as the client may not be in a state to attend to logical explanations and perceived criticisms should be avoided to prevent further escalation.

5. A 28-year-old woman is recovering from her third consecutive spontaneous abortion in 2 years. Which is the most therapeutic nursing intervention for this client at her follow-up appointment?

• A. Focusing on the client's physical needs
• B. Encouraging the client to verbalize her feelings about the loss
• C. Reminding the client that she will be able to become pregnant again
• D. Encouraging the client to think of herself, her husband, and their future

Correct answer: B

Rationale: The most therapeutic nursing intervention for a client recovering from multiple spontaneous abortions is to encourage the client to verbalize her feelings about the loss. This allows the client to express and process her emotions, facilitating the grieving process and emotional healing. Focusing solely on the client's physical needs, as in choice A, overlooks the importance of addressing the emotional aspect of the client's experience. Choice C, reminding the client that she will be able to become pregnant again, fails to acknowledge the current loss and may minimize the client's feelings of grief. Choice D, encouraging the client to think of herself, her husband, and their future, does not directly address the client's immediate emotional needs related to the recent loss. Therefore, choice B is the most appropriate intervention to support the client in coping with her emotional distress.

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