Nursing Elites

1. In performing a psychosocial assessment, the nurse begins by asking questions that encourage the client to describe problematic behaviors and situations. The next step is to elicit the client's

• A. feelings about what has been described.
• B. thoughts about what has been described.
• C. possible solutions to the problem.
• D. intent in sharing the description.

Correct answer: B

Rationale: In performing a psychosocial assessment, the nurse follows a structured approach, starting with encouraging the client to describe problematic behaviors and situations. The next step is to elicit the client's thoughts about what has been described. This step helps gather more assessment data and understand how the client interprets the situation. Asking about feelings, exploring possible solutions, and understanding the client's intent in sharing the description are more complex processes that come later in the assessment. Therefore, the correct next step after describing behaviors and situations is to inquire about the client's thoughts.

2. A client receiving preoperative instructions asks questions repeatedly about when to stop eating the night before the procedure. The nurse tries to refocus the client. The nurse notes that the client is frequently startled by noises in the hall. Assessment reveals rapid speech, trembling hands, tachypnea, tachycardia, and elevated blood pressure. The client admits to feeling nervous and having trouble sleeping. Based on the assessment, the nurse documents that the client has:

• A. mild anxiety.
• B. moderate anxiety.
• C. severe anxiety.
• D. a panic attack.

Correct answer: C

Rationale: The correct answer is 'severe anxiety.' In severe anxiety, a person focuses on small or scattered details and is unable to solve problems. The client's symptoms of rapid speech, trembling hands, tachypnea, tachycardia, elevated blood pressure, feeling nervous, and having trouble sleeping indicate severe anxiety. Mild anxiety enhances the ability to learn and solve problems, while moderate anxiety narrows the perceptual field but allows the client to notice things brought to their attention. During a panic attack, a person is disorganized, hyperactive, or unable to speak or act, which is not the case in this scenario.

3. After talking to the nurse, the charge nurse should:

• A. Report the incident to the Board of Nursing
• B. File a formal reprimand
• C. Terminate the nurse
• D. Charge the nurse with a tort

Correct answer: B

Rationale: The appropriate action after discussing the problem with the nurse is to document the incident and file a formal reprimand. Reporting to the Board of Nursing may be necessary if the behavior persists or harm occurs to the client, but it is not the initial step. Termination should be considered if the issue continues despite warnings. Charging the nurse with a tort is not a suitable course of action in this situation as a tort refers to a wrongful act against a client or their belongings, not an appropriate disciplinary measure. Therefore, choices A, C, and D are incorrect.

4. The women's health charge nurse is making assignments for the next shift. The unit is short one staff member and will receive a nurse from the medical-surgical unit. Which group of clients should she assign to the medical-surgical nurse?

• A. Total abdominal hysterectomy, bladder suspension with A&P repair, client with breast reduction
• B. C-section planning discharge, post-partum infection, mastectomy
• C. Vaginal delivery of fetal demise, C-section with pneumonia, 32-week gestation with lymphoma
• D. 28-week gestation of bed rest, post-partum with HELLP syndrome, breast reconstruction

Correct answer: A

Rationale: The correct answer includes clients who have undergone surgical procedures typically managed on a medical-surgical unit. Choice A consists of clients who have had elective surgical procedures such as hysterectomy, bladder suspension with A&P repair, and breast reduction, which are commonly treated in a medical-surgical setting. Choices B, C, and D involve clients with various complications related to childbirth, fetal demise, pneumonia, gestational lymphoma, HELLP syndrome, and bed rest, which are more complex cases requiring specialized care beyond medical-surgical nursing.

5. A man expresses surprise that his wife has become very withdrawn during hospitalization for pneumonia. Which response helps the husband understand how some people cope with hospitalization?

• A. "Hospitalization might cause a crisis. Has your wife had to cope with problems before this?"?
• B. "Some people react that way. She will be more talkative when she feels better."?
• C. "Your wife might be feeling concern that she cannot fulfill her normal roles."?
• D. "This is typical behavior for someone who is as ill as your wife."?

Correct answer: A

Rationale: The correct response acknowledges that hospitalization can lead to a crisis for both patients and their families. By asking if the wife has coped with problems before, it opens up a dialogue about her coping mechanisms and past experiences. This can help the husband understand his wife's current behavior better and provide valuable insights. Choices B, C, and D do not directly address the potential crisis that hospitalization can cause or inquire about the wife's coping strategies, making them less effective responses.

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