Nursing Elites

1. Which nursing intervention is most appropriate to maintain the patency of a client's nasogastric tube?

• A. Maintain a constant connection to low-intermittent suction
• B. Irrigate the tube as per physician's order
• C. Suction the mouth and nose every shift
• D. Perform a daily fecal occult blood sample

Correct answer: B

Rationale: The correct answer is to irrigate the tube as per physician's order. A client with a nasogastric tube is at risk of the tube kinking or clotting off, which can lead to complications such as abdominal distention or vomiting. To ensure the patency of the tube, the nurse should follow the physician's orders and facility policy to irrigate the tube with water or a solution as needed. Maintaining a constant connection to low-intermittent suction (Choice A) is not typically done to maintain tube patency. Suctioning the mouth and nose every shift (Choice C) is not directly related to maintaining nasogastric tube patency. Performing a daily fecal occult blood sample (Choice D) is unrelated to maintaining the patency of a nasogastric tube.

2. A child has recently been diagnosed with Duchenne muscular dystrophy (DMD). The parents are receiving genetic counseling prior to planning another pregnancy. Which of the following statements includes the most accurate information?

• A. Duchenne is an X-linked recessive disorder, so daughters have a 50% chance of being carriers and sons a 50% chance of developing the disease.
• B. Duchenne is an X-linked recessive disorder, so both daughters and sons have a 50% chance of developing the disease.
• C. Each child has a 1 in 4 (25%) chance of developing the disorder.
• D. Sons only have a 1 in 4 (25%) chance of developing the disorder.

Correct answer: A

Rationale: The correct answer is that Duchenne is an X-linked recessive disorder, meaning the affected gene is located on one of the two X chromosomes of a female carrier. If a son receives the X chromosome bearing the gene, he will develop the disease, giving him a 50% chance of being affected. Daughters, on the other hand, are not affected by Duchenne but have a 50% chance of being carriers since they inherit one copy of the defective gene from the mother. The other X chromosome is inherited from the father, who cannot be a carrier. Therefore, choice A is accurate. Choice B is incorrect because daughters do not develop the disease, and sons have a 50% chance of developing, not both having a 50% chance. Choice C is incorrect as it does not consider the X-linked inheritance pattern of Duchenne. Choice D is inaccurate as it incorrectly states that only sons have a 25% chance of developing the disorder, omitting the carrier status of daughters.

3. A new nursing unit is opening in the hospital. In order to meet the staffing needs of the unit, nurses from other areas will be moved and required to work in the new area. When notifying the nurses chosen to staff this area, the nurse manager states, 'You will either move to work on this unit or you will no longer be employed at this hospital.' Which of the following strategies is this nurse manager using?

• A. Manipulation
• B. Facilitation
• C. Co-optation
• D. Coercion

Correct answer: D

Rationale: The nurse manager in this scenario is using a coercion tactic to influence the nurses' job changes. Coercion involves using power to force others to make a choice. In this case, the nurses are left with no option but to either work on the new unit or face termination. Choice A, 'Manipulation,' is incorrect as manipulation involves influencing others through deceit or dishonesty, which is not evident in this situation. Choice B, 'Facilitation,' is incorrect as it refers to the process of making something easier or more convenient, which is not applicable here. Choice C, 'Co-optation,' involves absorbing or integrating individuals into a group, which does not align with the scenario described. Therefore, the most suitable term for the nurse manager's strategy is 'Coercion.'

4. Which of the following situations might warrant a laboratory magnesium level?

• A. Hyperthyroidism
• B. Arthritis
• C. Ulcerative colitis
• D. Depression

Correct answer: C

Rationale: Ulcerative colitis can lead to symptoms such as abdominal pain, fever, diarrhea, and weight loss. This condition may impact the absorption of certain nutrients, including magnesium. Therefore, patients with chronic gastrointestinal conditions like ulcerative colitis should be screened for electrolyte imbalances related to impaired digestion. Hyperthyroidism, arthritis, and depression do not typically directly affect magnesium levels in the same way as gastrointestinal conditions like ulcerative colitis.

5. A nurse is using active listening as a form of therapeutic communication when:

• A. She uses humor to put the client at ease in a situation
• B. She restates what the client said in slightly different words
• C. She uses eye contact and maintains an open stance while the client is talking
• D. She provides personal information to show the client she can relate to him

Correct answer: C

Rationale: Active listening is a form of therapeutic communication that involves the nurse encouraging a client to express their thoughts and feelings. Maintaining eye contact and an open stance while the client is talking demonstrates active listening and shows the client that they are being heard and understood. Using humor (Choice A) may not always be appropriate or therapeutic in all situations. Restating what the client said (Choice B) is a technique known as paraphrasing and is also a form of active listening. Providing personal information (Choice D) can shift the focus from the client to the nurse, which is not the intention of active listening.

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