Nursing Elites

1. Based on Maslow's hierarchy of needs, which client is demonstrating characteristics of self-actualization?

• A. Client is competent and esteemed by others for accomplishing work goals
• B. Client maintains a stable, loving, same-sex partnership for several years
• C. Client learns to sublimate aggressive impulses using physical exercises
• D. Client has an accurate perception of reality and is accepting of self and others

Correct answer: D

Rationale: According to Maslow's hierarchy of needs, self-actualization is the highest level where individuals strive to reach their full potential and achieve personal growth. A self-actualized person, as per Maslow, has an accurate perception of reality and is accepting of themselves and others. This individual is characterized by traits such as fairness, independence, spontaneity, and creativity. While choices A, B, and C represent important aspects of human needs fulfillment, they align more closely with lower levels in Maslow's hierarchy. Choice A refers to meeting self-esteem needs, choice B relates to love and belonging needs, and choice C addresses safety needs, all of which are below self-actualization in the hierarchy of needs.

2. An older Asian American patient tells the nurse that she has lived in the United States for 50 years. The patient speaks English and lives in a predominantly Asian neighborhood. Which action by the nurse is most appropriate?

• A. Include a shaman when planning the patient's care
• B. Avoid direct eye contact with the patient during care
• C. Ask the patient about any special cultural beliefs or practices
• D. Involve the patient's oldest son to assist with health care decisions

Correct answer: C

Rationale: The most appropriate action for the nurse in this scenario is to ask the patient about any special cultural beliefs or practices. This allows for a better understanding of the patient's individual cultural background and preferences related to healthcare. It is important to gather this information to provide culturally sensitive care. Choices A, B, and D are not appropriate actions. Including a shaman without the patient's request or consent may not align with the patient's beliefs or practices. Avoiding direct eye contact can be perceived as disrespectful in some cultures but should not be assumed without confirmation from the patient. Involving the patient's oldest son without the patient's consent or preference may not be appropriate and assumes family dynamics that may not be accurate.

3. Which benefit accompanies mild apprehension?

• A. Physiological functions are slowed.
• B. There is an increased alertness.
• C. Behavioral responses become automatic.
• D. Ego defense mechanisms are mobilized.

Correct answer: B

Rationale: A mild level of anxiety can be beneficial because it increases alertness and focuses attention. Physiological functions are actually amplified initially, not slowed, due to mild apprehension; however, prolonged anxiety can lead to decreased function due to exhaustion. Automatic behavioral responses and ego defense mechanisms may hinder an individual's awareness rather than enhancing it, making them less beneficial compared to increased alertness.

4. An increase in the neurotransmitter dopamine is associated with which of the following illnesses?

• A. Schizophrenia
• B. Depression
• C. Alzheimer's disease
• D. Anxiety

Correct answer: A

Rationale: An increase in the neurotransmitter dopamine is associated with schizophrenia. Dopamine dysregulation is linked to some symptoms of schizophrenia, such as hallucinations and delusions. Depression (choice B) is more commonly associated with abnormalities in serotonin and norepinephrine. Alzheimer's disease (choice C) is primarily characterized by deficits in acetylcholine and other neurotransmitters. Anxiety disorders (choice D) are often linked to imbalances in neurotransmitters like serotonin, norepinephrine, and GABA, rather than dopamine.

5. A client experiences postpartum hemorrhage eight hours after the birth of twins. Following administration of IV fluids and 500 ml of whole blood, her hemoglobin and hematocrit are within normal limits. She asks the nurse whether she should continue to breastfeed the infants. Which of the following is based on sound rationale?

• A. Nursing will help contract the uterus and reduce your risk of bleeding.
• B. Breastfeeding twins will take too much energy after the hemorrhage.
• C. The blood transfusion may increase the risks to you and the babies.
• D. Lactation should be delayed until the 'real milk' is secreted.

Correct answer: A

Rationale: The correct answer is 'Nursing will help contract the uterus and reduce your risk of bleeding.' Stimulation of the breast during nursing releases oxytocin, which contracts the uterus. This contraction is especially important following hemorrhage. Choice B is incorrect because breastfeeding can actually help prevent further bleeding by promoting uterine contractions. Choice C is incorrect as the blood transfusion is aimed at restoring the client's blood volume and should not significantly impact the babies. Choice D is incorrect as lactation should not be delayed, as breastfeeding can provide numerous benefits to both the mother and infants, including aiding in the prevention of postpartum hemorrhage.

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