Nursing Elites

1. The nurse is caring for a newly admitted patient. Which intervention is the best example of a culturally appropriate nursing intervention?

• A. Insist that family members provide most of the patient's personal care.
• B. Maintain a personal space of at least 2 feet when assessing the patient.
• C. Ask permission before touching a patient during the physical assessment.
• D. Consider the patient's ethnicity as an important factor in planning care.

Correct answer: C

Rationale: Culturally appropriate nursing care requires sensitivity to the beliefs and practices of diverse cultural groups. Asking permission before touching a patient during a physical assessment is a universally respectful practice, as many cultures consider it disrespectful to touch a person without consent. This approach demonstrates respect for the patient's autonomy and cultural preferences. Maintaining a personal space of at least 2 feet can be a good practice for infection control or personal comfort but may not be culturally significant for all patients. Insisting that family members provide most of the patient's personal care may not align with the patient's cultural norms or preferences. Considering a patient's ethnicity as the most important factor in care planning overlooks the individuality of the patient and may lead to stereotyping or assumptions that are not accurate or helpful in providing tailored care.

2. A female adolescent has anorexia nervosa and is malnourished and severely underweight. Which statement indicates that she is experiencing secondary gains from her behavior?

• A. "I'm huge; I'm as big as a house."
• B. "I get straight A's in all my subjects."
• C. "My mother keeps trying to get me to eat."
• D. "My hair is beginning to fall out in clumps."

Correct answer: C

Rationale: The statement "My mother keeps trying to get me to eat" indicates that the adolescent is experiencing secondary gains from her behavior. This is because the behavior has garnered attention from her mother, providing a sense of power and control, which are considered secondary gains. The statement "I'm huge; I'm as big as a house" reflects a disturbed body perception and is not related to secondary gains. Getting straight A's in all subjects is an achievement but not a secondary gain related to anorexia nervosa. The hair falling out in clumps is a physical consequence of starvation, not a secondary gain.

3. When a client with newly diagnosed chronic bronchitis tells the home health nurse about continuing to smoke 1 or 2 cigarettes a day and not doing the prescribed pulmonary physiotherapy exercises, which response by the nurse is best?

• A. ''Tell me about your typical day before you were diagnosed with chronic lung disease.''
• B. ''Smoking and not doing the exercises will make your lung disease continue to get worse.''
• C. 'I can't make you stop doing what you are doing, and it's your choice to be sick or well.''
• D. ''Your shortness of breath is probably because of your smoking and not doing the exercises.''

Correct answer: A

Rationale: Asking the client to describe a typical day is the best response. More data are needed about the client's usual activities of daily living so that the plan can be adapted to the client's preferences. The statement indicating that smoking and not doing the pulmonary exercises will allow the lung disease to progress is probably not news to the client and does not help in determining factors that might be contributing to nonadherence. The statement that the nurse cannot stop the client's behaviors indicates that the client is to blame and will place the client on the defensive. The statement that the client's dyspnea is caused by smoking and not doing the pulmonary exercises places the client on the defensive and will decrease trust, preventing the nurse from obtaining more information about why the client is nonadherent with the treatment plan.

4. A client who is in a late stage of pancreatic cancer intellectually understands the terminal nature of the illness. Which behaviors indicate the client is emotionally accepting the impending death?

• A. Revising the client's will and planning a visit to a friend
• B. Alternating between crying and talking openly about death
• C. Seeking second, third, and fourth medical opinions
• D. Refusing to follow treatments and stating they won't help anyway

Correct answer: A

Rationale: Revising the will and planning a visit to a friend are indicative of emotional acceptance of impending death as they demonstrate realistic, productive, and constructive ways of using the remaining time. Alternating between crying and talking openly about death may suggest depression rather than acceptance. Seeking multiple medical opinions shows disbelief, denial, or desperation rather than acceptance. Refusing treatments and stating they won't help reflects anger and hopelessness, not acceptance.

5. A term used to describe members of the same group based on physiological characteristics, such as skin color or body structure, is known as:

• A. Ethnicity
• B. Culture
• C. Race
• D. Minority

Correct answer: C

Rationale: The correct term used to describe members of the same group based on physiological characteristics, such as skin color or body structure, is 'Race.' Race categorizes people based on physical traits like skin color. Ethnicity refers to shared cultural characteristics, traditions, language, and heritage, not physical attributes. Culture encompasses the values, beliefs, behaviors, and practices shared by a group. 'Minority' refers to a smaller number or part compared to the whole, not specifically based on physiological characteristics.

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