Nursing Elites

1. A male client is laughing at a television program with his wife when the evening nurse enters the room. He says his foot is hurting and he would like a pain pill. How should the nurse respond?

• A. Ask him to rate his pain on a scale of 1 to 10.
• B. Encourage him to wait until bedtime so the pill can help him sleep.
• C. Attend to the acutely ill client's needs first because this client is laughing.
• D. Instruct him in the use of deep breathing exercises for pain control.

Correct answer: A

Rationale: Obtaining a subjective estimate of the pain experience by asking the client to rate his pain helps the nurse determine which pain medication should be administered and also provides a baseline for evaluating the effectiveness of the medication. Medicating for pain should not be delayed to use it as a sleep medication, so encouraging him to wait until bedtime is incorrect. Option C is judgmental and inappropriate as all clients deserve prompt attention. Option D should be used as an adjunct to pain medication, not instead of medication, so instructing him in deep breathing exercises alone is not the priority in this situation.

2. During the beginning phase of a therapeutic relationship, why is a clear understanding of participants' roles important?

• A. Understanding what will be discussed
• B. Knowing that the nurse is trying to be helpful
• C. Knowing what to expect from the relationship
• D. Preparing for termination of the relationship

Correct answer: C

Rationale: During the initial stages of a therapeutic relationship, having a clear understanding of participants' roles is crucial as it helps in defining the structure and boundaries of the relationship. This clarity assists in setting expectations and establishing a framework for interaction, allowing the client to focus on the therapeutic process rather than on uncertainties regarding their role or the nurse's role. Option A, understanding what will be discussed, is important but not directly related to defining roles. Option B, knowing that the nurse is trying to be helpful, is about the intent of the nurse rather than the roles of the participants. Option D, preparing for termination of the relationship, is premature in the beginning phase and not directly related to understanding roles.

3. A female nurse is assessing a male patient of Arab descent who is admitted with complaints of severe headaches. It is most important for the nurse to intervene if she takes which action?

• A. The nurse explains the 0 to 10 intensity pain scale.
• B. The nurse asks the patient when the headaches started.
• C. The nurse sits down at the bedside and closes the privacy curtain.
• D. The nurse calls for a male nurse to bring a hospital gown to the room.

Correct answer: C

Rationale: In some Arab cultures, it is not considered appropriate for a male to be alone with a female who is not his spouse. Therefore, it is important for the nurse to respect the patient's cultural beliefs and privacy by ensuring that a female nurse is not alone with the male patient. Sitting down at the bedside and closing the privacy curtain could potentially lead to a situation where the nurse is alone with the patient, which goes against the patient's cultural norms. The other actions, such as explaining the pain scale, asking about the onset of headaches, and requesting a male nurse to bring a hospital gown, are all appropriate and do not conflict with the patient's cultural beliefs.

4. During a survey, the community nurse meets a client who has not visited a gynecologist after the birth of her second child. The client says that her mother or sister never had annual gynecologic examinations. Which factor is influencing the client's health practices?

• A. Spiritual beliefs
• B. Family practices
• C. Emotional factors
• D. Cultural background

Correct answer: B

Rationale: The correct answer is 'Family practices.' In this scenario, the client's health practices are influenced by the fact that her family members never had annual gynecologic examinations, leading her to believe that such preventive care measures are unnecessary. This highlights the impact of familial behavior on an individual's perception of healthcare. Spiritual beliefs are not the primary factor at play here; they may affect the choice of medical treatment but not the decision to seek preventive care. Emotional factors like stress or fear could influence health practices, but there is no indication of this in the client's case. Cultural background would come into play if the client followed specific health beliefs or customary practices related to illness and health restoration.

5. A client becomes angry while waiting for a supervised break to smoke a cigarette outside and states, 'I want to go outside now and smoke. It takes forever to get anything done here!' Which intervention is best for the nurse to implement?

• A. Encourage the client to use a nicotine patch.
• B. Reassure the client that it is almost time for another break.
• C. Have the client leave the unit with another staff member.
• D. Review the schedule of outdoor breaks with the client.

Correct answer: D

Rationale: The best nursing action is to review the schedule of outdoor breaks and provide concrete information about the schedule. Suggesting a nicotine patch (Option A) is not suitable as the client wants to smoke. Reassuring the client about another break (Option B) does not address the client's frustration and does not promote effective communication. Having the client leave the unit with another staff member (Option C) is not appropriate as it goes against unit rules and does not address the client's concerns. Therefore, the most appropriate intervention is to review the schedule of outdoor breaks with the client to provide clarity and address the client's frustration effectively.

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