Nursing Elites

1. A mother has just given birth to a baby who died soon after. The mother has been crying and states, "I can't believe this has happened to me. I did everything right during this pregnancy."? How should the nurse respond to this mother?

• A. Tell her she did nothing wrong; it was God's will.
• B. Tell her she can have another baby.
• C. Tell her that her behavior is not going to solve anything.
• D. Tell her nothing and let her mourn this loss in the manner she chooses.

Correct answer: D

Rationale: Perinatal loss is a significant tragedy for parents, and it is crucial to provide sensitive and compassionate care. When a mother expresses her disbelief and feelings of doing everything right during the pregnancy, it is important for the nurse to acknowledge her pain and allow her to grieve in her way. Telling her that she did nothing wrong and it was God's will (Choice A) may not be comforting and can come across as dismissive of her feelings. Suggesting she can have another baby (Choice B) is insensitive and overlooks the grief she is experiencing for the current loss. Telling her that her behavior is not going to solve anything (Choice C) is invalidating her emotions and not supportive in this situation. Therefore, the best approach is to support her in her mourning process by respecting her feelings and allowing her to express her grief as she sees fit.

2. When providing culturally competent care to a couple from the Philippines living in the United States who are expecting their first child, what should the nurse do first?

• A. review their own cultural beliefs and biases
• B. respectfully request that the couple only use medically approved health care providers
• C. understand the clients' need to learn the accepted medical practices of their new country
• D. study family dynamics to comprehend the male and female gender roles in the clients' culture

Correct answer: A

Rationale: When providing culturally competent care, the nurse's initial step is to reflect on and understand their own cultural beliefs and biases. By doing so, the nurse can approach the care of the couple from the Philippines with sensitivity and respect. This self-awareness helps the nurse recognize potential differences in beliefs and values, fostering effective communication and care. Option B is incorrect because it does not address the nurse's need for self-reflection. Option C is incorrect as it focuses on the clients adapting to the new country's practices rather than the nurse understanding the clients' existing beliefs. Option D is incorrect as it pertains to family dynamics and gender roles rather than the nurse's self-awareness.

3. A client goes to the mental health center for difficulty concentrating, insomnia, and nightmares. The client reports being raped as a child. The nurse should assess the client for further signs of:

• A. generalized anxiety disorder.
• B. schizophrenia.
• C. post-traumatic stress disorder.
• D. bipolar disorder.

Correct answer: C

Rationale: Given the history of childhood sexual abuse and the presenting symptoms of difficulty concentrating, insomnia, and nightmares, the nurse should assess the client for post-traumatic stress disorder (PTSD). Childhood sexual abuse is strongly associated with adult-onset depression and an increased risk for PTSD. Individuals with PTSD may exhibit re-experiencing symptoms such as flashbacks, nightmares, and heightened reactions to trauma triggers. They may also display emotional numbing, avoidance behaviors, and increased arousal symptoms like difficulty sleeping and hypervigilance. Generalized anxiety disorder (Choice A) is characterized by excessive worry and anxiety about various events or activities, not necessarily tied to a specific trauma. Schizophrenia (Choice B) is a severe mental disorder characterized by distortions in thinking, perception, emotions, and behavior, unrelated to the traumatic event described. Bipolar disorder (Choice D) involves mood swings between depressive and manic episodes, and its symptoms differ from those typically seen in PTSD.

4. A 60-year-old widower is hospitalized after complaining of difficulty sleeping, extreme apprehension, shortness of breath, and a sense of impending doom. What is the best response by the nurse?

• A. "You have nothing to worry about. You are in a safe place. Try to relax."?
• B. "Has anything happened recently or in the past that might have triggered these feelings?"?
• C. "We have given you a medication that helps to decrease feelings of anxiety."?
• D. "Take some deep breaths and try to calm down."?

Correct answer: B

Rationale: Choice B is the best response as it shows empathy, acknowledges the patient's feelings, and opens the door for discussion about potential triggers for anxiety. This approach helps the patient explore the root cause of his anxiety and provides an opportunity for therapeutic communication. Choice A dismisses the patient's feelings and offers false reassurance, which may not address the underlying issue. Choices C and D do not encourage the patient to express his emotions or delve into the reasons behind his anxiety, hindering the therapeutic process.

5. The new mother asks why her baby has lost weight since he was born. The best explanation of the weight loss is:

• A. The baby is dehydrated due to polyuria.
• B. The baby is hypoglycemic due to lack of glucose.
• C. The baby is allergic to the formula the mother is giving him.
• D. The baby can lose up to 10% of weight due to meconium stool, loss of extracellular fluid, and initiation of breastfeeding.

Correct answer: D

Rationale: After birth, newborns can lose weight due to meconium stool, loss of extracellular fluid, and the initiation of breastfeeding. This weight loss is a normal and expected physiological process, and infants can lose up to 10% of their birth weight during this period. There is no indication of dehydration (polyuria), hypoglycemia (lack of glucose), or allergy to the formula as reasons for weight loss in newborns. Therefore, answers A, B, and C are incorrect. Answer D provides the most accurate explanation for the observed weight loss in the newborn.

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