Nursing Elites

1. In a clinic in a primarily African American community, a higher incidence of uncontrolled hypertension is noted in patients. To correct this health disparity, what should the nurse do first?

• A. Initiate a regular home-visit program by clinic nurses.
• B. Schedule teaching sessions about low-salt diets at community events.
• C. Assess the perceptions of community members about the care at the clinic.
• D. Obtain low-cost antihypertensive drugs using government grant funding.

Correct answer: C

Rationale: To address the higher incidence of uncontrolled hypertension in the primarily African American community, the nurse should first assess the perceptions of community members about the care at the clinic. Understanding the community's perspective can provide valuable insights into the reasons behind the health disparity. Initiating a regular home-visit program or scheduling teaching sessions about low-salt diets are important interventions but should come after gathering information on community perceptions. Obtaining low-cost antihypertensive drugs is not the initial priority; understanding community perspectives is crucial for developing effective interventions.

2. A client on lithium has diarrhea and vomiting. What should the nurse do first?

• A. Recognize this as a drug interaction
• B. Give the client Cogentin
• C. Reassure the client that these are common side effects of lithium therapy
• D. Hold the next dose and obtain an order for a stat serum lithium level

Correct answer: D

Rationale: Diarrhea and vomiting are manifestations of lithium toxicity. The priority action for the nurse is to hold the next dose of lithium and obtain an order for a stat serum lithium level to confirm toxicity. This ensures patient safety and prevents further harm. Recognizing it as a drug interaction is not the first step in this scenario. Cogentin is used to manage extrapyramidal symptoms (EPS) associated with antipsychotics, not lithium toxicity. Reassuring the client about these symptoms as common side effects of lithium therapy is inappropriate as they indicate a more serious issue than typical side effects like hand tremors, nausea, polyuria, and polydipsia.

3. Research participants are involved in a trial that incidentally separates them into two groups. One group receives an intervention, while the other group does not. Both groups are compared for outcomes. What type of research method is this?

• A. Experimental design
• B. Double-blind experiment
• C. Randomized controlled trial
• D. Repeated measures design

Correct answer: C

Rationale: A randomized controlled trial is a research method in which participants are randomly assigned to either a treatment or control group. This design helps eliminate bias and allows for the comparison of outcomes between the two groups. In this scenario, where participants are separated into intervention and non-intervention groups for comparison, it aligns with the characteristics of a randomized controlled trial. The key feature distinguishing it from the other options is the random assignment of participants to groups, ensuring that both groups are comparable at the start of the study. Double-blind experiments involve blinding both participants and researchers to treatment allocation, which is not explicitly mentioned in the scenario. Experimental design refers to a broader category that includes various types of research designs beyond just randomized controlled trials. Repeated measures design involves collecting multiple observations from the same participants over time, which is not the case described in the scenario.

4. A 27-year-old writer is admitted for the second time accompanied by his wife. He is demanding, arrogant, talks fast, and is hyperactive. Initially the nurse should plan this for a manic client:

• A. Set realistic limits to the client's behavior
• B. Repeat verbal instructions as often as needed
• C. Allow the client to express feelings to relieve tension
• D. Assign staff to be with the client at all times to help maintain control

Correct answer: A

Rationale: For a manic client who is hyperactive and may engage in injurious activities, setting realistic limits to the client's behavior is crucial to ensure safety. A quiet environment with firm and consistent limits helps in managing the client's behavior effectively. While repeating verbal instructions can be helpful due to the client's distractibility, it is not the priority compared to setting limits for safety concerns. Allowing the client to express feelings is important, but it should be done through non-destructive methods. Assigning staff to be with the client at all times is not realistic or feasible in the clinical setting and does not address the core issue of managing the client's behavior and ensuring safety.

5. Gio told his nurse that the FBI is monitoring and recording his every movement and that microphones have been placed in the unit walls. Which action would be the most therapeutic response?

• A. Confront the delusional material directly by telling Gio that this simply is not so.
• B. Tell Gio that this must seem frightening to him but that you believe he is safe here.
• C. Tell Gio to wait and talk about these beliefs in his one-on-one counseling sessions.
• D. Isolate Gio when he begins to talk about these beliefs.

Correct answer: B

Rationale: The most therapeutic response in this situation is to acknowledge Gio's feelings of fear and validate his experience by expressing empathy ('this must seem frightening to him'). By reassuring Gio that he is safe in the current environment, the nurse can help reduce his anxiety and build trust. Choice A is not recommended as directly confronting delusional beliefs may lead to increased distress and resistance. Choice C delays addressing Gio's concerns and may not provide immediate support. Choice D of isolating Gio can worsen his feelings of paranoia and distrust in the treatment setting.

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