Nursing Elites

1. The nurse plans care for a hospitalized patient who uses culturally based treatments. Which action by the nurse is best?

• A. Encourage the use of diagnostic procedures.
• B. Coordinate the use of folk treatments with ordered medical therapies.
• C. Ask the patient to discontinue the cultural treatments during hospitalization.
• D. Teach the patient that folk remedies will interfere with orders by the healthcare provider.

Correct answer: B

Rationale: The best action for the nurse is to coordinate the use of folk treatments with ordered medical therapies. Many culturally based therapies can complement Western treatments and medications. It is essential for the nurse to integrate both traditional folk treatments and Western therapies to provide holistic care. Some culturally based treatments can effectively complement Western medicine in treating diseases. Encouraging the patient to continue some culturally based treatments during hospitalization can enhance their overall well-being. Asking the patient to discontinue cultural treatments or teaching that folk remedies interfere with Western therapies may not align with the patient's beliefs and could hinder their care.

2. Urinary catheterization is prescribed for a postoperative female client who has been unable to void for 8 hours. The nurse inserts the catheter, but no urine is seen in the tubing. What should the nurse do next?

• A. Clamp the catheter and recheck it in 60 minutes.
• B. Pull the catheter back 3 inches and redirect upward.
• C. Leave the catheter in place and reattempt with another catheter.
• D. Notify the healthcare provider of a possible obstruction.

Correct answer: C

Rationale: When no urine is seen in the tubing after inserting a catheter in a female client who has not voided for 8 hours, it is possible that the catheter is in the vagina rather than the bladder. Leaving the initial catheter in place can help locate the meatus for the second attempt. The client should have at least 240 mL of urine output after 8 hours, indicating the need for catheterization. Clamping the catheter (Option A) does not address the issue of incorrect catheter placement. Pulling the catheter back and redirecting it (Option B) is not effective unless the catheter is completely removed, requiring a new catheter. There is no indication of a urinary tract obstruction to notify the healthcare provider (Option D) as the catheter could be inserted easily.

3. A client has been diagnosed with a form of terminal cancer and has started receiving hospice care. The nurse notes that both the client and his family avoid talking about the diagnosis. All attempts at discussion result in changing the subject. The nurse recognizes that this family is exhibiting:

• A. Closed awareness
• B. Mutual pretense
• C. Open awareness
• D. Powerless assessment

Correct answer: B

Rationale: The correct answer is 'Mutual pretense.' Mutual pretense is a form of awareness as a response to death or dying in which those involved avoid discussing the situation. In this scenario, both the client and the family are aware of the terminal cancer diagnosis, but they choose not to talk about it openly. This behavior can stem from various reasons, such as trying to shield loved ones from grief, fear of the future, or discomfort with discussing emotions. 'Closed awareness' (Choice A) refers to a lack of awareness of the impending death, which is not the case here. 'Open awareness' (Choice C) involves open acknowledgment and discussion of the terminal illness, which is contrary to the behavior described. 'Powerless assessment' (Choice D) does not relate to the situation of avoiding discussing the diagnosis in the context of terminal cancer and hospice care.

4. What is the best intervention for a client with borderline personality disorder?

• A. Establishing clear boundaries
• B. Exploring vocational possibilities
• C. Discussing feelings of victimization
• D. Spending 1 to 2 hours per day with the client

Correct answer: A

Rationale: The best intervention for a client with borderline personality disorder is to establish clear boundaries. Individuals with this disorder struggle with impulsivity and have difficulty recognizing and respecting boundaries in their relationships. By establishing clear boundaries, it helps provide structure and consistency to the client, aiding in their treatment and management of the disorder. Exploring vocational possibilities may be important at some point, but it is not the priority intervention for managing borderline personality disorder. Discussing feelings of victimization, while common, may not be as effective initially due to the client's lack of insight and resistance. Spending 1 to 2 hours per day with the client may not be as productive as shorter, more focused interactions that are geared towards boundary reinforcement.

5. According to Erikson's theory, which behavior would the nurse expect a preschooler to exhibit?

• A. The child develops the superego.
• B. The child plays beside other children.
• C. The child concentrates on work and play.
• D. The child becomes casual about body appearance.

Correct answer: A

Rationale: According to Erikson's theory, a preschooler develops the superego or conscience during the initiative versus guilt stage. This stage occurs around ages 3 to 6 years old. The development of the superego is crucial for the child to start understanding and internalizing societal and parental values. Choice B is incorrect because playing beside other children typically occurs during the autonomy versus shame and doubt stage, which is seen in toddlers. Choice C is incorrect as concentrating on work and play is more characteristic of the industry versus inferiority stage, typically seen in school-aged children. Choice D is incorrect because becoming casual about body appearance is more aligned with the identity versus role confusion stage, which is seen in adolescents who have a marked preoccupation with appearance and body image.

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