Nursing Elites

1. The nurse is caring for a client scheduled for a surgical repair of a sacular abdominal aortic aneurysm. Which assessment is most crucial during the preoperative period?

• A. Assessment of the client's level of anxiety
• B. Evaluation of the client's exercise tolerance
• C. Identification of peripheral pulses
• D. Assessment of bowel sounds and activity

Correct answer: C

Rationale: The most crucial assessment during the preoperative period for a client scheduled for surgical repair of a sacular abdominal aortic aneurysm is the identification of peripheral pulses. This is essential because during surgery, the aorta will be clamped, potentially affecting blood circulation to the kidneys and lower extremities. Monitoring peripheral pulses helps assess circulation to the lower extremities, ensuring adequate perfusion. While assessing the client's anxiety level (choice A) is important, it is not as critical as monitoring peripheral pulses in this case. Evaluating exercise tolerance (choice B) is not typically recommended preoperatively for this specific condition. Assessing bowel sounds and activity (choice D) is also relevant but takes a lower priority compared to identifying peripheral pulses in this scenario.

2. A 26-year-old single woman is knocked down and robbed while walking her dog one evening. Three months later, she presents at the crisis clinic, stating that she cannot put this experience out of her mind. She complains of nightmares, extreme fear of being outside or alone, and difficulty eating and sleeping. What is the best response by the nurse?

• A. "I will ask the physician to prescribe medication for you."?
• B. "That must have been a very difficult and frightening experience. It might be helpful to talk about it."?
• C. "In the future, you might walk your dog in a more populated area or hire someone else to take over this task."?
• D. "Have you thought of moving to a safer neighborhood?"?

Correct answer: B

Rationale: Choice B is the best response as it provides empathy and encourages the client to talk about her experience, which can be therapeutic. This approach validates the client's feelings and offers support. By acknowledging the difficulty and fear experienced by the client, the nurse opens the door for the client to express her emotions and begin the process of coping with the trauma. Choices A, C, and D do not address the emotional impact of the traumatic event or provide an opportunity for the client to express her feelings and concerns. Choice A immediately jumps to medication without exploring other supportive interventions. Choice C focuses on practical solutions without addressing the client's emotional needs. Choice D suggests a drastic solution without considering the client's emotional state or preferences.

3. Due to a high census, it has been necessary for a number of clients to be transferred to other units within the hospital. Which client should be transferred to the postpartum unit?

• A. A 66-year-old female with gastroenteritis
• B. A 40-year-old female with a hysterectomy
• C. A 27-year-old male with severe depression
• D. A 28-year-old male with ulcerative colitis

Correct answer: B

Rationale: The best client to transfer to the postpartum unit is the 40-year-old female with a hysterectomy. The nurses on the postpartum unit will be knowledgeable about postoperative care and can manage any complications related to the surgery. Choices A and D would be more appropriately cared for on a medical-surgical unit due to their conditions. Choice C should be transferred to a psychiatric unit for specialized care related to severe depression.

4. To decrease a client's use of denial and increase the client's expression of feelings, what should the nurse do?

• A. Tell the client to stop using the defense mechanism of denial
• B. Positively reinforce each expression of feelings
• C. Instruct the client to express feelings
• D. Challenge the client each time denial is used

Correct answer: B

Rationale: The most appropriate approach to decrease a client's use of denial and promote the expression of feelings is to positively reinforce each expression of feelings. This method helps the client feel supported and validated, encouraging them to continue expressing their emotions openly. Positively reinforcing the expression of feelings can help reduce the need for denial as the client learns that their emotions are acknowledged and accepted. Choices A, C, and D are incorrect. Choice A of telling the client to stop using denial is too directive and may be ineffective. Instructing the client to express feelings (Choice C) lacks positive reinforcement, and challenging the client each time denial is used (Choice D) can create a confrontational environment that hinders therapeutic progress.

5. The client is taking prednisone 7.5mg po each morning to treat his systemic lupus erythematosus. Which statement best explains the reason for taking the prednisone in the morning?

• A. There is less chance of forgetting the medication if taken in the morning.
• B. There will be less fluid retention if taken in the morning.
• C. Prednisone is absorbed best with the breakfast meal.
• D. Morning administration mimics the body's natural secretion of corticosteroid.

Correct answer: D

Rationale: Taking corticosteroids in the morning mimics the body's natural release of cortisol, which follows a diurnal pattern with higher levels in the morning. This timing helps regulate the body's inflammatory response and minimizes potential side effects. Answer A is not the primary reason for morning dosing, as adherence concerns can be addressed through other means. Answer B is incorrect since fluid retention is not influenced by the timing of prednisone administration. Answer C is also incorrect as prednisone absorption is not significantly affected by whether it is taken with breakfast or not.

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