Nursing Elites

1. 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.

2. A toddler is 26 months old and has been recently admitted to the hospital. According to Erikson, which of the following stages is the toddler in?

• A. Trust vs. mistrust
• B. Initiative vs. guilt
• C. Autonomy vs. shame and doubt
• D. Intimacy vs. isolation

Correct answer: C

Rationale: The correct stage for a toddler who is 26 months old, according to Erik Erikson's stages of psychosocial development, is Autonomy vs. shame and doubt. This stage occurs between 18 months to 3 years of age. During this stage, children are focused on developing a greater sense of control and independence. Choice A, Trust vs. mistrust, is the first stage occurring from birth to 18 months, where infants learn to trust or mistrust their caregivers based on their care. Choice B, Initiative vs. guilt, is the third stage occurring from 3 to 5 years, where children start to assert themselves more. Choice D, Intimacy vs. isolation, is a stage occurring in adulthood, not relevant to a toddler's development.

3. Which of the following medications would NOT be an appropriate prn medication for use during an episode of aggression or violence for the patient with a psychiatric diagnosis?

• A. Olanzapine
• B. Meperidine
• C. Ziprasidone
• D. Haloperidol

Correct answer: B

Rationale: Meperidine is an opioid used to treat pain and is not suitable for managing aggressive or violent behavior in patients with psychiatric diagnoses. Olanzapine, ziprasidone, and haloperidol are appropriate choices for managing aggression or violence. Olanzapine and ziprasidone are second-generation antipsychotic medications, while haloperidol is a traditional antipsychotic. These medications have demonstrated effectiveness in managing aggressive behavior, with or without the adjunctive use of a benzodiazepine. Meperidine's primary indication is for pain relief, making it unsuitable for managing psychiatric-related aggression or violence.

4. Which communication technique is a part of therapeutic communication?

• A. Asking for explanations
• B. Showing sympathy to the client
• C. Asking personal questions of the client
• D. Providing relevant information to the client

Correct answer: D

Rationale: The correct answer is providing relevant information to the client. In therapeutic communication, it is essential to provide clients with all pertinent information to help them understand their health status and what to expect. This empowers clients and promotes trust in the nurse-client relationship. Asking for explanations, showing sympathy, and asking personal questions are examples of nontherapeutic communication techniques. Asking personal questions can intrude on the client's privacy and may not be relevant to their care. Showing sympathy, while well-intentioned, may come across as pity rather than true empathy. Asking for explanations can sometimes put clients on the defensive rather than fostering a collaborative dialogue.

5. During the evacuation of a group of clients from a medical unit due to a fire, the nurse observes an ambulatory client walking alone toward the stairway at the end of the hall. What action should the nurse take?

• A. Assign an unlicensed assistive person to transport the client via a wheelchair.
• B. Remind the client to walk carefully down the stairs until reaching a lower floor.
• C. Ask the client to help by assisting a wheelchair-bound client to a nearby elevator.
• D. Open the closest fire doors so that ambulatory clients can evacuate more rapidly.

Correct answer: B

Rationale: During the evacuation of a unit due to a fire, ambulatory clients should be evacuated via the stairway if possible and reminded to walk carefully to ensure their safety. They do not necessarily require assistance via a wheelchair. Elevators should not be used during a fire evacuation as they can pose a risk, and fire doors should be kept closed to contain the fire and smoke, preventing its spread to other areas of the building. Therefore, reminding the client to walk carefully down the stairs is the most appropriate action in this situation. Assigning an unlicensed assistive person to transport the client via a wheelchair may delay the evacuation process and put both individuals at risk. Asking the client to help by assisting a wheelchair-bound client to an elevator is not safe during a fire evacuation. Opening fire doors indiscriminately can lead to the spread of fire and smoke, endangering the clients and staff further.

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