Nursing Elites

1. A client with stage IV lung cancer is 3 days postoperative following a wedge resection. The client states, “I told myself that I would go through with the surgery and quit smoking, if I could just live long enough to attend my child’s wedding.” Based on the Kubler-Ross model, which stage of grief is the client experiencing?

• A. Anger
• B. Denial
• C. Bargaining
• D. Acceptance

Correct answer: C

Rationale: The client is in the bargaining stage of grief according to the Kubler-Ross model. In this stage, individuals negotiate for more time to achieve specific goals or fulfill desires. The client's statement about quitting smoking to attend their child's wedding reflects this bargaining behavior. Anger (choice A) is characterized by frustration and resentment, denial (choice B) involves avoidance of reality, and acceptance (choice D) signifies coming to terms with the situation, none of which align with the client's current mindset of bargaining.

2. A nurse is caring for an adolescent client who has full-thickness burns on his leg. The client expresses concern about his future. Which of the following is a therapeutic response by the nurse?

• A. “You’re concerned about what will happen when you leave the hospital?”
• B. “If you work hard on your physical therapy, you won’t need to worry.”
• C. “You shouldn’t worry about the future so you can concentrate on getting well.”
• D. “Why are you concerned even though everyone is here to help you?”

Correct answer: A

Rationale: The correct response is A, “You’re concerned about what will happen when you leave the hospital?” This response acknowledges the client's concerns about the future, validating their feelings and encouraging open communication. It shows empathy and allows the client to express their worries. Choice B minimizes the client's concerns by suggesting that they won't need to worry if they work hard on physical therapy, which may invalidate their emotions. Choice C dismisses the client's worry, implying that they should ignore their concerns to focus on getting well. Choice D uses a confrontational approach by questioning the client's concerns, which may discourage open communication and make the client feel defensive.

3. When evaluating a client's use of a cane, which action should the nurse identify as an indication of correct use?

• A. The client's stronger side holds the cane
• B. The top of the cane is parallel to the client's waist
• C. The client holds the cane on the stronger side of their body
• D. The client moves the cane 46 cm (18 in) forward

Correct answer: C

Rationale: The correct way to use a cane is to hold it on the stronger side of the body. This helps to provide support and maintain alignment. Option A is incorrect because the cane should be held on the stronger side, not the weaker side. Option B is incorrect as the top of the cane should be at the level of the greater trochanter, not the waist. Option D is incorrect because the client should move the weaker limb forward with the cane for stability.

4. A client is immobile due to a cast, and a nurse is assisting in the use of a fracture bedpan. Which of the following actions should the nurse take?

• A. Place the shallow end of the fracture pan under the client’s buttocks.
• B. Encourage the client to remain immobile on the fracture pan for 20 minutes.
• C. Keep the bed flat while the client is on the fracture pan.
• D. Hyperextend the client’s back while the fracture pan is in place.

Correct answer: A

Rationale: The correct action when using a fracture bedpan for an immobile client is to place the shallow end of the pan under the client's buttocks. This positioning helps in proper collection of feces without causing discomfort or injury. Encouraging the client to try to defecate for 20 minutes (Choice B) is inappropriate and unrealistic, as defecation should not be forced or timed. Keeping the bed flat (Choice C) is incorrect as elevating the head of the bed can help promote proper positioning for bedpan use. Hyperextending the client's back (Choice D) is contraindicated and can lead to discomfort and potential injury to the client.

5. A healthcare professional is reviewing a client’s medications. They include cimetidine and imipramine. Knowing that cimetidine decreases the metabolism of imipramine, the healthcare professional should identify that this combination is likely to result in which of the following effects?

• A. Decreased therapeutic effects of cimetidine
• B. Increased risk of imipramine toxicity
• C. Decreased risk of adverse effects of cimetidine
• D. Increased therapeutic effects of imipramine

Correct answer: B

Rationale: When cimetidine decreases the metabolism of imipramine, it leads to an increased concentration of imipramine in the body, which can result in imipramine toxicity. This increased risk of toxicity is the likely effect of this drug interaction. Choice A is incorrect because cimetidine's effect on imipramine metabolism does not impact the therapeutic effects of cimetidine. Choice C is incorrect because the interaction does not decrease the risk of adverse effects of cimetidine. Choice D is incorrect as the increased concentration of imipramine can lead to toxicity, not increased therapeutic effects.

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