Nursing Elites

1. The licensed practical nurse assigned to the postpartum unit is preparing to administer Rhogam to a postpartum client. Which woman is not a candidate for RhoGam?

• A. A gravida IV para 3 that is Rh negative with an Rh-positive baby
• B. A gravida I para 1 that is Rh negative with an Rh-positive baby
• C. A gravida II para 0 that is Rh negative admitted after a stillbirth delivery
• D. A gravida IV para 2 that is Rh negative with an Rh-negative baby

Correct answer: D

Rationale: The mothers in answers A, B, and C all require RhoGam as they are Rh negative with an Rh-positive baby or have experienced a stillbirth delivery, making them candidates for RhoGam injection. The mother in answer D is the only one who does not require Rhogam because she is Rh negative with an Rh-negative baby, eliminating the need for RhoGam administration.

2. Lidocaine is a medication frequently ordered for the client experiencing

• A. Atrial tachycardia
• B. Ventricular tachycardia
• C. Heart block
• D. Ventricular bradycardia

Correct answer: B

Rationale: Lidocaine is used to treat ventricular tachycardia. This medication slowly exerts an antiarrhythmic effect by increasing the electrical stimulation threshold of the ventricles without depressing the force of ventricular contractions. It is not used for atrial arrhythmias; thus, answer A is incorrect. Answers C and D are incorrect because lidocaine does not slow the heart rate, so it is not used for heart block or bradycardia.

3. When supporting a family who has just experienced a sudden and unexpected death, the nurse needs to know:

• A. that survivors have greater emotional turmoil and shock than when death is expected.
• B. that survivors have less emotional turmoil and shock than when death is expected.
• C. that survivors have the same emotional turmoil and shock as when death is expected.
• D. that survivors have little emotional turmoil and shock because they were not there.

Correct answer: A

Rationale: The correct answer is that survivors have greater emotional turmoil and shock than when death is expected. Sudden death produces more emotional turmoil and shock in survivors compared to gradual, expected death. Survivors of sudden death do not have the opportunity to engage in anticipatory grief. The unexpectedness of sudden death is the most disturbing and unbalancing factor, leading to heightened emotional turmoil and shock. Choice B is incorrect as survivors of sudden death experience more emotional turmoil and shock. Choice C is incorrect because sudden death brings about a different level of emotional turmoil and shock. Choice D is incorrect as survivors of sudden and unexpected death still go through significant emotional distress.

4. A client has rectal cancer and is scheduled for an abdominal perineal resection. What should be the priority nursing care during the post-op period?

• A. Teaching perineal wound care techniques
• B. Monitoring electrolyte levels
• C. Encouraging early ambulation
• D. Facilitating perineal wound drainage

Correct answer: D

Rationale: The priority nursing care during the post-op period for a client who underwent an abdominal perineal resection is to facilitate perineal wound drainage. This is crucial for preventing infection of the surgical site and promoting healing. Teaching perineal wound care techniques, as in choice A, is more appropriate than ileostomy care in this scenario. While monitoring electrolyte levels is important, it is not the priority compared to ensuring proper wound drainage, making choice B less crucial. Encouraging early ambulation, as in choice C, is beneficial but not as critical as facilitating wound drainage immediately post-op.

5. What type of relief behavior is Ashley using to cope with emotional conflict?

• A. acting out
• B. somatizing
• C. withdrawal
• D. problem-solving

Correct answer: B

Rationale: Ashley is somatizing by experiencing emotional conflict as physical symptoms associated with severe anxiety. Somatizing involves converting emotions into physical symptoms. Acting out involves behaviors like anger, crying, and verbal abuse, not physical symptoms. Withdrawal is when one withdraws psychic energy in response to anxiety, not converting emotions into physical symptoms. Problem-solving occurs when anxiety is identified and the underlying need is addressed, not converting emotions into physical symptoms.

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