Nursing Elites

1. James returns home from school angry and upset because his teacher gave him a low grade on an assignment. After returning home from school, he kicks the dog. This coping mechanism is known as:

• A. denial
• B. suppression
• C. displacement
• D. fantasy

Correct answer: C

Rationale: Displacement is the transference of emotions, such as anger, to a substitute target that may be less threatening. In this scenario, James redirects his anger from the teacher to the dog. Denial is refusing to acknowledge an aspect of reality. Suppression is consciously putting aside unwanted thoughts or feelings. Fantasy involves imagining unrealistic scenarios. Therefore, in this case, the correct answer is displacement as James displaces his anger towards the dog.

2. When assessing a client in crisis, what should the nurse prioritize?

• A. Allowing the client to work through independent problem-solving.
• B. Completing an in-depth evaluation of stressors and responses to the situation.
• C. Focusing on immediate stress reduction.
• D. Recommending ongoing therapy.

Correct answer: C

Rationale: When a client is in crisis, the nurse's priority is to focus on immediate stress reduction. Crisis intervention aims to stabilize the client in the present moment by addressing the most pressing issues. Allowing the client to work through independent problem-solving (Choice A) may not be appropriate during a crisis as they might need immediate support. Completing an in-depth evaluation of stressors (Choice B) is important but not the immediate priority during a crisis. Recommending ongoing therapy (Choice D) may be considered later, but the immediate focus should be on reducing the client's stress and stabilizing the situation.

3. A nurse notes that an elderly client suddenly does not keep appointments and is not wearing appropriate clothing. Which statement by the client raises the suspicion of financial abuse?

• A. "I am having difficulty paying for this new antibiotic the physician prescribed."?
• B. "I am a little short on cash since my daughter moved in to help me."?
• C. "I have not felt like shopping since the weather has gotten worse."?
• D. "People do not realize how difficult it is to make ends meet on a fixed income."?

Correct answer: B

Rationale: The correct answer is B: "I am a little short on cash since my daughter moved in to help me."? This statement raises suspicion of financial abuse as it suggests a recent change in financial circumstances after the daughter moved in. Financial abuse in elderly clients can be indicated by sudden unexplained financial deficits or changes, such as difficulty paying for necessities despite previously being able to do so. Choices A, C, and D do not directly imply a recent financial change due to external factors, making them less indicative of potential financial abuse. Option B is the most concerning statement that warrants further investigation into possible financial exploitation.

4. The nurse is working with families who have been displaced by a fire in an apartment complex. What is the priority intervention during the initial assessment?

• A. Provide a liaison to meet housing needs.
• B. Attentively listen when clients describe their feelings.
• C. Offer nurturing support for clients who are confused by the events.
• D. Provide structure for clients exhibiting moderate to severe anxiety.

Correct answer: A

Rationale: The correct answer is to provide a liaison to meet housing needs. In the initial assessment after a disaster like a fire, ensuring basic needs such as housing, clothing, and food are met is the priority. Once the physical needs are addressed, the nurse can then focus on assisting clients in managing the psychological effects of loss. Choices B, C, and D are not the priority during the initial assessment as addressing housing needs should come first to provide a sense of stability and security for the affected families.

5. A client visits the clinic after the death of a parent. Which statement made by the client's sister signifies abnormal grieving?

• A. "My sister still has episodes of crying, and it's been 3 months since Daddy died."?
• B. "Sally seems to have forgotten the bad things that Daddy did in his lifetime."?
• C. "She really had a hard time after Daddy's funeral. She said that she had a sense of longing."?
• D. "Sally has not been sad at all about Daddy's death. She acts like nothing has happened."?

Correct answer: D

Rationale: Abnormal grieving is often characterized by a lack of sadness or acknowledgment of the loss. In this scenario, the statement 'Sally has not been sad at all about Daddy's death. She acts like nothing has happened' indicates abnormal grieving as it suggests a lack of emotional response or denial of the death. On the other hand, choices A, B, and C all describe normal grieving reactions: crying episodes, selective memory of the deceased, and feelings of longing after the funeral. These responses are typical in the grieving process. Therefore, choice D is the correct answer, highlighting a potential abnormality in the grieving process.

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