Nursing Elites

1. The nurse is caring for a client with a malignancy. The classification of the primary tumor is Tis. The nurse should plan care for a tumor:

• A. That can be assessed
• B. That is in situ
• C. With increasing lymph node involvement
• D. With distant metastasis

Correct answer: B

Rationale: The correct answer is B: 'That is in situ.' Cancer in situ means that the cancer is still localized to the primary site. Cancer is graded in terms of tumor, grade, node involvement, and metastasis. Answer A is incorrect because Tis indicates a tumor that is in situ and can be assessed. Answer C is incorrect because T indicates tumor, not node involvement. Answer D is incorrect because a tumor that is in situ is not metastasized.

2. The nurse observes bilateral bruises on the arms of an elderly client in a long-term care facility. Which of the following questions should the nurse ask this client?

• A. "How did you get those bruises?"?
• B. "Did someone grab you by your arms?"?
• C. "Do you fall often?"?
• D. "What did you bump against?"?

Correct answer: B

Rationale: When addressing suspected abuse, it is crucial to ask direct questions to determine the cause of injuries. Choice B is the most appropriate as it directly inquires about the possibility of someone grabbing the client's arms, which could indicate abuse. This question can help uncover potential abuse and provide necessary intervention. Choices A, C, and D are less direct and may not elicit the critical information needed to address abuse effectively. Clients often hesitate to report abuse due to feelings of shame and fear of retaliation, making a direct approach essential in such situations.

3. All of the following are common reasons that nurses are reluctant to delegate except:

• A. lack of self-confidence
• B. desire to maintain authority
• C. confidence in subordinate
• D. getting trapped in the 'I can do it better myself' mindset

Correct answer: C

Rationale: If a delegator has confidence in their subordinates and believes a task will be performed correctly, they are more likely to delegate. Reasons nurses may be reluctant to delegate include their own lack of self-confidence, the desire to maintain authority, and getting trapped in the 'I can do it better myself' mindset. Therefore, 'confidence in subordinate' is the exception as it actually encourages delegation. The other choices are common barriers to delegation in healthcare settings.

4. 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.

5. In performing a psychosocial assessment, the nurse begins by asking questions that encourage the client to describe problematic behaviors and situations. The next step is to elicit the client's:

• A. feelings about what has been described
• B. thoughts about what has been described
• C. possible solutions to the problem
• D. intent in sharing the description

Correct answer: B

Rationale: In a psychosocial assessment, the nurse should progress from having the client describe problematic behaviors to eliciting their thoughts about the dilemmas. This step provides essential assessment data and insights into the client's interpretation of the situation. Asking about feelings, solutions, or intent in sharing the description is premature at this stage. Understanding the client's thoughts is crucial before delving into more complex emotional or problem-solving aspects. Therefore, the correct answer is to elicit the client's thoughts about the described behaviors and situations, as this helps the nurse gain a deeper understanding of the client's perspective and thought processes.

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