Nursing Elites

1. The nurse is teaching a client about the healthy use of ego defense mechanisms. An appropriate goal for this client would be

• A. Reduce fear and protect self-esteem
• B. Minimize anxiety and delay apprehension
• C. Avoid conflict and leave unpleasant situations
• D. Increase independence and communicate more effectively

Correct answer: A

Rationale: The correct answer is A: 'Reduce fear and protect self-esteem.' When teaching a client about the healthy use of ego defense mechanisms, the goal is to help the individual manage emotions effectively without denying reality. Using defense mechanisms in a healthy way aims to reduce fear and protect self-esteem while still addressing underlying issues. Choices B, C, and D are incorrect because they do not focus on the core principles of using defense mechanisms in a healthy manner. Minimizing anxiety and delaying apprehension, avoiding conflict and leaving unpleasant situations, and increasing independence and communicating more effectively do not directly align with the goal of utilizing ego defense mechanisms in a constructive way.

2. You attended a home delivery with the Rural Health midwife. The newborn is premature. Which of the following should be included in premature infant care at home?

• A. establishing and maintaining good respiration
• B. proper management of feeding
• C. minimum handling of the baby
• D. regulation of body temperature

Correct answer: D

Rationale: Corrected Rationale: Regulation of body temperature is crucial for the survival of a premature infant. Premature infants have difficulty regulating their body temperature, making it essential to keep them warm. While establishing and maintaining good respiration and proper feeding management are important aspects of infant care, they are not as critical as regulating body temperature for premature infants. Additionally, while minimizing handling to reduce stress can be beneficial, it is not as vital as temperature regulation for premature infants.

3. You are teaching a client about the patient-controlled analgesia (PCA) planned for post-operative care. Which statement indicates further teaching may be needed by the client?

• A. ''I will be receiving continuous doses of medication.''
• B. ''I should call the nurse before I take additional doses.''
• C. ''I will call for assistance if my pain is not relieved.''
• D. ''The machine will prevent an overdose.''

Correct answer: B

Rationale: PCA allows patients to self-administer pain medication within prescribed limits, without the need to call the nurse before taking an additional dose. Choice B suggests a misunderstanding of how PCA works, as the patient should be educated that they can self-administer doses within the safety parameters set by the healthcare provider. Choices A, C, and D demonstrate proper understanding of PCA, hence are not indicative of needing further teaching.

4. A person with no known illness whose daily routine consists of walking and following a healthy diet would be best characterized as engaging in which kind of activities?

• A. health balance
• B. disease prevention
• C. health promotion
• D. self-fulfillment

Correct answer: C

Rationale: The correct answer is C: health promotion. Health promotion activities involve maintaining a healthy lifestyle to prevent illness. In this scenario, the person is actively engaging in behaviors that promote their overall health and well-being, such as walking and following a healthy diet. Choice A, 'health balance,' is vague and does not specifically address the proactive nature of the person's actions. Choice B, 'disease prevention,' while related, focuses more on specific actions taken to prevent diseases rather than the broader concept of promoting overall health. Choice D, 'self-fulfillment,' does not directly relate to the activities described in the question.

5. What does the nurse perform to determine the family nursing problems/needs?

• A. goal setting
• B. family health care plan formulation
• C. assessment
• D. evaluation

Correct answer: C

Rationale: The correct answer is C: assessment. Assessment is the initial step in identifying family nursing problems/needs. During assessment, the nurse collects data to understand the family's health status, strengths, weaknesses, and potential areas for intervention. This process helps in developing an accurate picture of the family's situation. Choices A, B, and D are incorrect because goal setting, family health care plan formulation, and evaluation come after the assessment phase. Goal setting occurs once the issues are identified, the family health care plan is developed based on assessment findings, and evaluation is the final step to assess the effectiveness of the interventions implemented.

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