Nursing Elites

1. Which of the following coping mechanisms protects an individual from anxiety?

• A. denial and fantasy
• B. rationalization and suppression
• C. regression and displacement
• D. reaction formation and projection

Correct answer: A

Rationale: The correct answer is 'denial and fantasy.' Denial involves blocking external events from awareness to avoid anxiety, while fantasy is escaping to a more comfortable, less threatening place. These mechanisms can protect individuals from anxiety by providing temporary relief or distraction. Choices B, C, and D are incorrect. Rationalization and suppression do not directly protect individuals from anxiety. Regression and displacement involve reverting to earlier developmental stages or redirecting emotions to a substitute target, which do not directly shield individuals from anxiety. Reaction formation and projection entail behaving in the opposite way to one's impulses or attributing one's feelings to others respectively, which do not directly protect individuals from anxiety.

2. Which information should be reported to the state Board of Nursing?

• A. The facility fails to provide literature in both Spanish and English.
• B. The narcotic count has been incorrect on the unit for the past 3 days.
• C. The client fails to receive an itemized account of his bills and services received during his hospital stay.
• D. The nursing assistant assigned to the client with hepatitis fails to feed the client and give the bath.

Correct answer: B

Rationale: The correct answer is 'The narcotic count has been incorrect on the unit for the past 3 days.' This information should be reported to the state Board of Nursing as it involves medication errors and potential drug diversion, which are serious issues that fall under the jurisdiction of the Board. Reporting medication discrepancies and errors in narcotic counts is crucial for patient safety and regulatory compliance. Choices A, C, and D involve different types of issues that are not within the direct purview of the Board of Nursing. Providing literature in multiple languages (Choice A), addressing billing practices (Choice C), and resolving staff performance issues (Choice D) should be handled internally or reported to the appropriate departments or authorities, such as the Joint Commission or the charge nurse.

3. What are the three major sequential maturational crises for females?

• A. puberty, pregnancy, and menopause.
• B. death of a spouse, menopause, and childbirth.
• C. rape, divorce, and menarche.
• D. dating, engagement, and separation.

Correct answer: A

Rationale: The three major sequential maturational crises affecting females are puberty, pregnancy, and menopause. Puberty signifies the beginning of menarche, the first menstrual period. Pregnancy is a transformative experience with long-lasting effects on a woman's life. Menopause marks the end of menstrual cycles. These milestones are well-documented in research and are significant events in a woman's life. Nurses play a vital role in supporting females through these stages. Choices B, C, and D are incorrect as they do not accurately represent the recognized sequential maturational crises in a female's life.

4. A client has been taking alprazolam (Xanax) for four years to manage anxiety. The client reports taking 0.5 mg four times a day. Which statement indicates that the client understands the nurse's teaching about discontinuing the medication?

• A. "I can drink alcohol now that I am decreasing my Xanax."?
• B. "I should not take another Xanax pill. Here is what is left of my last prescription."?
• C. "I should take three pills per day next week, then two pills for one week, then one pill for one week."?
• D. "I can expect to be sleepy for several days after stopping the medicine."?

Correct answer: C

Rationale: Explanation: When discontinuing alprazolam (Xanax) after long-term use, it is crucial to taper the dosage gradually to prevent withdrawal symptoms. The correct statement indicates an understanding of this by planning a structured decrease in dosage over time. Choice A is incorrect as drinking alcohol while decreasing Xanax can be dangerous and is not recommended. Choice B is incorrect as abruptly stopping Xanax is not safe and can lead to withdrawal symptoms. Choice D is incorrect as expecting to be sleepy for several days after stopping the medication does not address the need for a gradual tapering process to avoid withdrawal symptoms.

5. The nurse is caring for a dying client who has persistently requested that the nurse 'help her to die and be in peace.' According to the Code of Ethics for Nurses, the nurse should:

• A. Ask the client if she has signed an advance directives document.
• B. Tell the client that another nurse will be assigned to care for her.
• C. Instruct the client that only a physician can legally assist in suicide.
• D. Try to make the client as comfortable as possible, but refuse to assist in death.

Correct answer: D

Rationale: According to the Code of Ethics for Nurses, the nurse should try to make the client as comfortable as possible but refuse to assist in death. It is not within the scope of nursing practice to assist in death, even if requested by the client. Choice A is incorrect as advance directives do not directly relate to the client's request for assistance in dying. Choice B is inappropriate as passing the responsibility to another nurse does not address the ethical dilemma at hand. Choice C is incorrect because instructing the client that only a physician can legally assist in suicide does not address the ethical considerations involved in the request. Therefore, the most appropriate action for the nurse is to provide comfort measures while upholding ethical standards and not participating in ending the client's life.

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