Nursing Elites

1. A mother complains to the nurse that her 3-year-old child refuses to go to preschool. The child rarely interacts and avoids playing with other children. Which statement would the nurse provide?

• A. Do not be concerned because all toddlers behave this way.
• B. Ask the teacher to push the child to speak up and open up to the other kids.
• C. Set boundaries and supervise the child closely.
• D. Give your child time to get acquainted and warm up to the new environment.

Correct answer: D

Rationale: According to the mother's description, the child is a slow-to-warm-up child. These children are uneasy in new situations or with unfamiliar people. The nurse would educate the mother to give the child time to be more familiar with the new environment. All toddlers do not behave in the same manner. A slow-to-warm-up child should not be pressured to do anything against his or her wishes. Setting boundaries and closely supervising the child is not the best approach for a child who needs time to adapt. Asking the teacher to push the child to open up can create more anxiety and stress for the child, which is not recommended.

2. Which parental statement would the nurse recognize as the appropriate application of time-out when disciplining a 4-year-old?

• A. I send my child to their bedroom for misbehaving.
• B. We limit time-out to 4 minutes per incident.
• C. Putting my child in a dark closet for time-out is very effective.
• D. I explain the reason for the time-out before and after disciplining my child.

Correct answer: D

Rationale: The correct answer is to explain the reason for the time-out before and after disciplining the child. This approach reinforces the child's association of the time-out with the undesirable behavior, helping the child learn to control those behaviors. Sending a child to their bedroom may lead to negative associations with bedtime or be ineffective if the child enjoys spending time in their bedroom. Time-out should ideally be limited to 1 minute per year of age, so a time-out for a 4-year-old should be limited to 4 minutes. Placing a child in a dark closet can create fear and damage the child's trust in their parents as a source of safety, making it an inappropriate and harmful approach. Even if this method seems effective in the short term, the potential long-term consequences outweigh any immediate benefits.

3. A seriously ill female client tells the nurse, 'I am so tired and in so much pain! Please help me to die.' Which is the best response for the nurse to provide?

• A. Administer the prescribed maximum dose of pain medication.
• B. Talk with the client about her feelings related to her own death.
• C. Collaborate with the healthcare provider about initiating antidepressant therapy.
• D. Refer the client to the ethics committee of her local healthcare facility.

Correct answer: B

Rationale: The nurse should first assess the client's feelings about her death and determine the extent to which this statement expresses her true feelings. The client may need additional pain management, but further assessment is needed before implementing option A. Option B is the correct response as it focuses on addressing the client's emotional needs and providing support. Option C is premature as initiating antidepressant therapy without a thorough assessment may not be appropriate. Option D is not the best course of action at this point; involving the ethics committee should be considered only after a comprehensive evaluation and discussion with the client.

4. Which defense mechanism would the nurse conclude a female client with obsessive-compulsive disorder, who washes her hands more than 20 times a day, is using to ease anxiety?

• A. Undoing
• B. Projection
• C. Introjection
• D. Displacement

Correct answer: A

Rationale: The correct answer is 'Undoing.' Undoing is a defense mechanism where the individual tries to negate a previous act to relieve guilt or anxiety. In this case, the client washing her hands excessively is trying to 'undo' perceived contamination or guilt associated with not washing. Projection (choice B) involves attributing one's own unacceptable thoughts or impulses to others, which is not demonstrated in this scenario. Introjection (choice C) is the process of internalizing beliefs or values of others, which is also not applicable in this context. Displacement (choice D) involves redirecting emotions from one target to another, which does not align with the client's behavior of handwashing as a response to anxiety in this case.

5. At a senior citizens meeting, a healthcare professional talks with a client who has Type 1 diabetes mellitus. Which statement by the client during the conversation is most predictive of a potential for impaired skin integrity?

• A. ''I give myself insulin injections in my thighs.''
• B. ''Sometimes when I put my shoes on, I don't know where my toes are.''
• C. ''Here are my glucose readings that I noted on my calendar.''
• D. ''If I bathe more than once a week, my skin feels too dry.''

Correct answer: B

Rationale: The correct answer is when the client states, ''Sometimes when I put my shoes on, I don't know where my toes are.'' This statement indicates peripheral neuropathy, which can lead to a lack of sensation in the lower extremities. When clients are unable to feel pressure or pain in their feet, they are at a high risk for skin impairment, such as cuts, wounds, or ulcers. Option A is not directly related to impaired skin integrity, as self-administering insulin in the thighs does not pose a direct risk to skin integrity. Option C shows good glucose monitoring, which is important but does not directly indicate impaired skin integrity. Option D suggests dry skin due to infrequent bathing, which is more related to general skin care and not as predictive of impaired skin integrity as the statement in Option B.

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