Nursing Elites

1. A man reports his wife is constantly cleaning, which interferes with family life. Friends avoid visiting due to feeling uncomfortable. The husband finds her cleaning even at night. The nurse should consult and recommend the husband help with therapy by:

• A. telling his wife to stop cleaning whenever he notices her actions.
• B. making a baseline record of the time the wife spends cleaning.
• C. decreasing the stimuli in the home.
• D. helping his wife with the cleaning.

Correct answer: C

Rationale: The correct answer is to decrease the stimuli in the home. The wife's behavior suggests obsessive-compulsive disorder, an anxiety disorder. By reducing stimuli in the environment, such as clutter or triggers that prompt cleaning, it helps in managing the condition and promoting a calmer atmosphere. Option A is incorrect as directly telling the wife to stop can escalate her anxiety. Option B is not the priority initially, as addressing the root cause is more crucial. Option D may reinforce the behavior rather than addressing the underlying issue.

2. Narrow therapeutic index medications:

• A. are drug formulations with limited pharmacokinetic variability.
• B. have limited value and require no monitoring of blood levels.
• C. have less than a twofold difference in minimum toxic levels and minimum effective concentration in the blood
• D. have limited potency and side effects.

Correct answer: C

Rationale: The therapeutic index is the ratio between the median lethal dose and median effective dose of a drug, indicating the safety margin. Narrow therapeutic index medications have a small difference between minimum toxic levels and minimum effective concentration in the blood, making them high-risk drugs that require close monitoring to avoid toxicity. Choice A is incorrect because pharmacokinetics refer to drug absorption, distribution, metabolism, and elimination, not the therapeutic index. Choice B is incorrect because narrow therapeutic index drugs necessitate monitoring due to their narrow margin of safety. Choice D is incorrect because narrow therapeutic index drugs do not necessarily have limited potency but are characterized by a small window between efficacy and toxicity.

3. The nurse who was not promoted then went to the utility room and slammed several cupboard doors while looking for Kleenex. This behavior exemplifies:

• A. displacement.
• B. sublimation
• C. conversion.
• D. reaction formation.

Correct answer: A.

Rationale: Displacement unconsciously transfers emotions associated with a person, object, or situation to another less threatening person, object, or situation. In this scenario, the nurse slammed doors instead of expressing anger towards the promoted nurse or the administrator who made the promotion decision. Sublimation is the unconscious process of substituting constructive activity for unacceptable impulses. Since slamming cupboard doors is not a constructive activity, this choice is incorrect. Conversion involves transforming anxiety into physical symptoms, which is not demonstrated in the given behavior. Reaction formation keeps unacceptable feelings or behaviors out of awareness by displaying the opposite feeling or behavior, which is not the case here.

4. A twenty-one-year-old man suffered a concussion, and the MD ordered an MRI. The patient asks, 'Will they allow me to sit up during the MRI?' The correct response by the nurse should be:

• A. "I will have to talk to the doctor about letting you sit upright during the test."?
• B. "You will be positioned in the reverse Trendelenburg position to maximize the view of the brain."?
• C. "The radiologist will let you know."?
• D. "You will have to lie down on your back during the test."?

Correct answer: D

Rationale: The correct answer is to inform the patient that they will have to lie down on their back during the MRI. This positioning is necessary for the scan to obtain accurate images of the brain. Choice A is incorrect because the decision on the positioning during the MRI is typically determined by the imaging protocol and not subject to negotiation during the test. Choice B is incorrect as the reverse Trendelenburg position is not commonly used during MRI scans. Choice C is incorrect because the radiologist does not usually make decisions on patient positioning during the MRI; it is predetermined by the imaging requirements.

5. Social support systems include all of the following except:

• A. call-in help lines
• B. emotional assistance provided by others
• C. community support groups
• D. use of coping skills and verbalization for anger management

Correct answer: D

Rationale: The correct answer is the use of coping skills and verbalization for anger management. Social support systems involve external sources of support from others or the community. Call-in help lines, emotional assistance provided by others, and community support groups all represent social support systems where individuals can seek help and assistance from outside sources. On the other hand, the use of coping skills and verbalization for anger management refers to individual strategies rather than external social support.

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