Nursing Elites

1. What significant event occurs in the orientation phase of a nurse-client relationship?

• A. establishment of roles
• B. identification of transference phenomenon
• C. placement of the client within their family structure
• D. client agreement that the nurse has the authority in the relationship

Correct answer: B

Rationale: In the orientation phase of a nurse-client relationship, the significant event is the identification of transference phenomenon. Transference phenomena are intensified in relationships with authority figures like nurses and physicians. Positive transferences may include a desire for affection and dependency, while negative transferences may involve hostility and competitiveness. It is crucial to recognize and address these transferences before progress and positive changes can be made in the working stage. The other choices are incorrect; the establishment of roles may occur in the working phase, placing the client within their family structure is not a key event in the orientation phase, and client agreement on the nurse's authority is not the primary focus during this phase.

2. A corporate executive works 60-80 hours a week. The client is experiencing some physical signs of stress. The nurse teaches the client biofeedback techniques. This is an example of which of the following health-promotion interventions?

• A. structure
• B. relaxation technique
• C. time management
• D. regular exercise

Correct answer: C

Rationale: The correct answer is 'relaxation technique.' Biofeedback techniques are a form of relaxation technique that can help individuals quiet the mind, release tension, and counteract responses to stress. Teaching biofeedback techniques to the client aims to promote relaxation and stress management. Choice A, 'structure,' does not directly relate to teaching biofeedback techniques. Choice C, 'time management,' focuses on organizing tasks efficiently, not on relaxation techniques. Choice D, 'regular exercise,' although beneficial for overall health, is not specifically related to the teaching of biofeedback techniques for stress relief.

3. A client reports hearing voices. What should the nurse do next?

• A. Touch the client to help him return to reality.
• B. Leave the client alone until reality returns.
• C. Ask the client to describe what is happening.
• D. Tell the client there are no voices.

Correct answer: C

Rationale: When a client reports hearing voices, it might indicate hallucinations. It is essential for the nurse to ask the client to describe what is happening to gain a better understanding of the hallucinations. This approach helps in assessing the severity and content of the hallucinations, which can guide further interventions. Touching the client without consent can be intrusive and may escalate the situation, violating the client's personal space. Leaving the client alone may not address the underlying issue of hallucinations and can lead to potential risks if the client is distressed. Telling the client there are no voices denies their experience, invalidates their feelings, and can result in mistrust between the client and the nurse.

4. In the emergency room, a nurse is responsible for triaging four clients injured in a motor vehicle accident. Which of the following clients should receive priority in care?

• A. A 10-year-old with lacerations on the face
• B. A 15-year-old with sternal bruises
• C. A 34-year-old with a fractured femur
• D. A 50-year-old with a dislocated elbow

Correct answer: B

Rationale: The 15-year-old with sternal bruises should receive priority in care as this client might be experiencing airway and oxygenation problems. Airway issues take precedence in triage. The 10-year-old with lacerations on the face, although looking bad, is not in immediate distress. The 34-year-old with a fractured femur should be immobilized but can be seen after the client with sternal bruising. The 50-year-old with a dislocated elbow can also be seen later as dislocated elbows are not life-threatening compared to potential airway compromise.

5. The physician has ordered sodium warfarin (Coumadin) for the client with thrombophlebitis. The order should be entered to administer the medication at:

• A. 900
• B. 1200
• C. 1700
• D. 2100

Correct answer: C

Rationale: Sodium warfarin is typically administered in the late afternoon, around 1700 hours. This timing allows for accurate bleeding times to be drawn in the morning. Administering it at 0900 (choice A) would not align with this schedule and may affect the monitoring of bleeding times. Choice B (1200) is midday, which is not the recommended time for sodium warfarin administration. Choice D (2100) is in the evening, which is also not ideal. Therefore, the correct time for administering sodium warfarin is 1700 (choice C).

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