Nursing Elites

1. Which approach would be most appropriate for the involved parent of a child diagnosed with Munchausen syndrome by proxy?

• A. Confrontation
• B. Open communication
• C. Health teaching about childrearing
• D. Validation of the child's physical status

Correct answer: B

Rationale: The most appropriate approach for the involved parent of a child diagnosed with Munchausen syndrome by proxy is open communication. Maintaining open communication is crucial in building a therapeutic nurse-client relationship. Confrontation may cause the parent to become defensive and hinder effective communication. Health teaching about childrearing may not be well-received at this point as the parent may not be ready for it. Validation of the child's physical status may inadvertently reinforce the parent's behavior by focusing solely on physical symptoms rather than addressing the underlying issues.

2. The nurse plans to administer diazepam, 4 mg IV push, to a client with severe anxiety. How many milliliters should the nurse administer? (Round to the nearest tenth.)

• A. 0.2 mL
• B. 0.8 mL
• C. 1.25 mL
• D. 2.0 mL

Correct answer: B

Rationale: To calculate the volume to administer, use the formula: (Volume to administer = (Ordered Dose � Volume on hand) / Dose on hand). In this case, it would be (4 mg � 1 mL) / 5 mg = 0.8 mL. Therefore, the nurse should administer 0.8 mL of diazepam. Choice A (0.2 mL) is incorrect because it miscalculates the dosage. Choice C (1.25 mL) and Choice D (2.0 mL) are incorrect as they do not align with the correct calculation based on the ordered dose and available concentration. The correct answer, 0.8 mL, is derived from accurate dosage calculation and aligns with the formula for IV medication administration, ensuring the safe and effective delivery of the medication to the client.

3. A client admitted with a diagnosis of cervical cancer tells the nurse, 'I haven't had a Papanicolaou (Pap) smear for more than 8 years. I probably wouldn't be in the hospital today if I'd had those tests more often.' Which response would the nurse provide?

• A. ''Please tell me why you waited so long.''
• B. 'You feel as though you've neglected your health.''
• C. 'It's never too late to start taking care of yourself.''
• D. 'Most women hate to have Pap smears done, but they're really important.''

Correct answer: B

Rationale: The correct response, ''You feel as though you've neglected your health,'' is appropriate as it indicates recognition of expressed feelings, encouraging verbalization. This response is nondirective and reflective. Choice A, asking the client why she waited so long, ignores the client's current emotional needs and may cut off communication. Choice C, stating that it is never too late to start taking care of her health, is judgmental as it implies that the client has been negligent. Choice D, although acknowledging the importance of Pap smears, fails to address the client's current emotional state and needs.

4. The nurse develops a goal that makes a client feel as if they are engaging in a competition. Which type of motivation is the nurse using in this situation?

• A. Power motivation
• B. Affiliative motivation
• C. Avoidance motivation
• D. Achievement motivation

Correct answer: A

Rationale: The nurse is using power motivation in this situation. Power-motivated individuals tend to have assertive and aggressive behavior. By designing goals that make clients feel like they are in a competition, the nurse appeals to their need for power and accomplishment, even when they are competing against themselves. Affiliative motivation is characterized by nonassertive behavior and dependence on others, which is not applicable here. Avoidance motivation focuses on anxiety, fear of failure, and phobias, which are not relevant to the scenario. Achievement motivation does not involve aggressive behavior or the need for competition, making it an incorrect choice for this scenario.

5. An adolescent client comes to the clinic 3 weeks after the birth of her first baby. She tells the nurse she is concerned because she has not returned to her pre-pregnant weight. Which action should the nurse perform first?

• A. Review the client's weight pattern over the year
• B. Ask the mother to record her diet for the last 24 hours
• C. Encourage her to talk about her view of herself
• D. Give her several pamphlets on postpartum nutrition

Correct answer: C

Rationale: Encouraging the adolescent client to talk about her view of herself is the first action the nurse should take. Body image is crucial for adolescents, especially after pregnancy. By addressing the client's concerns about her weight and discussing her self-perception, the nurse can provide emotional support and open a dialogue for further assessment and teaching. Choice A, 'Review the client's weight pattern over the year,' is not the priority at this time as the client's immediate concern is her post-pregnancy weight. Choice B, 'Ask the mother to record her diet for the last 24 hours,' focuses on dietary habits rather than addressing the client's emotional concerns. Choice D, 'Give her several pamphlets on postpartum nutrition,' may be helpful but should come after addressing the client's emotional needs and concerns.

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