Nursing Elites

1. When a nurse assigned to a manipulative client for 5 days becomes aware of feelings of reluctance to interact with the client, the next action by the nurse should be to

• A. Discuss the feeling of reluctance with an objective peer or supervisor
• B. Limit contacts with the client to avoid reinforcement of manipulative behavior
• C. Confront the client about the negative effects of behaviors on other clients and staff
• D. Develop a behavior modification plan that will promote more functional behavior

Correct answer: A

Rationale: When a nurse experiences reluctance to interact with a manipulative client, it is essential to address these feelings constructively. Discussing the feeling of reluctance with an objective peer or supervisor allows the nurse to gain perspective, reflect on the situation, and develop appropriate strategies for patient care. This action promotes self-awareness, professional growth, and ensures that patient care is not compromised. Option B is incorrect because avoiding the client may not address the underlying issues and can impact the therapeutic relationship. Option C is inappropriate as confronting the client may escalate the situation and hinder effective communication. Option D is not the immediate action needed in this scenario, as it focuses on behavior modification rather than addressing the nurse's feelings of reluctance.

2. A nurse is caring for a client who has a surgical wound. Which of the following laboratory values places the client at risk for poor wound healing?

• A. Serum albumin 3 g/dL
• B. Total lymphocyte count 2400/mm3
• C. HCT 42%
• D. HGB 16 g/dL

Correct answer: A

Rationale: The correct answer is A: Serum albumin 3 g/dL. Low levels of serum albumin indicate poor nutritional status and can impair wound healing. Total lymphocyte count, HCT, and HGB levels are not directly related to wound healing and do not pose a significant risk for poor wound healing in this context. Total lymphocyte count reflects the immune status, HCT measures the percentage of red blood cells in blood, and HGB measures the amount of hemoglobin in blood.

3. A healthcare provider is providing discharge teaching to a client who does not speak the same language. Which of the following actions should the healthcare provider take?

• A. Use proper medical terms when providing instructions to the client.
• B. Offer written instructions in the client’s language.
• C. Direct verbal discharge instructions to the interpreter.
• D. Request that an assistive personnel interpret instructions for the client.

Correct answer: B

Rationale: The correct action for the healthcare provider when providing discharge teaching to a client who does not speak the same language is to offer written instructions in the client’s language. This approach helps ensure better comprehension and adherence to the instructions as the client can refer back to the written material for clarification. Choice A is incorrect because using proper medical terms may not be effective if the client does not understand the language. Choice C is incorrect since verbal instructions should be directed to the client for better understanding. Choice D is incorrect as assistive personnel may not be qualified or trained to provide accurate interpretation, risking miscommunication and potential errors in the instructions.

4. What finding signifies that children have attained the stage of concrete operations according to Piaget?

• A. Demonstrates exploration of the environment through sight and movement
• B. Thinks in mental images or word pictures
• C. Makes the moral judgment that 'stealing is wrong'
• D. Reasons that homework is time-consuming yet necessary

Correct answer: C

Rationale: The correct answer is C, 'Makes the moral judgment that 'stealing is wrong''. This finding signifies the attainment of the concrete operational stage according to Piaget. At this stage, children begin to understand rules and logic, including moral judgments. Choice A is incorrect because it does not specifically relate to concrete operational thinking. Choice B is incorrect as it refers more to the preoperational stage where children engage in symbolic thought. Choice D is also incorrect as it involves practical reasoning, which is not directly related to the concrete operational stage according to Piaget.

5. A client has an indwelling urinary catheter. Which of the following assessment findings indicates that the catheter requires irrigation?

• A. Bladder scan shows 525 mL of urine
• B. Urine has a strong odor
• C. The client reports abdominal discomfort
• D. The catheter is blocked or not draining

Correct answer: D

Rationale: The correct answer is D because if the catheter is blocked or not draining, it may need irrigation to restore proper flow. Option A, 'Bladder scan shows 525 mL of urine,' does not necessarily indicate the need for irrigation as it could be within the expected range for catheter drainage. Option B, 'Urine has a strong odor,' may indicate a urinary tract infection but does not directly correlate with the need for catheter irrigation. Option C, 'The client reports abdominal discomfort,' could indicate various issues but does not specifically suggest the need for catheter irrigation.

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