Nursing Elites

1. Which serum laboratory value should the nurse monitor carefully for a client who has a nasogastric (NG) tube to suction for the past week?

• A. White blood cell count
• B. Albumin
• C. Calcium
• D. Sodium

Correct answer: D

Rationale: The nurse should monitor the client's serum sodium levels carefully when they have been on nasogastric (NG) tube suction for an extended period. Prolonged NG suctioning can lead to fluid loss and subsequent hyponatremia. Monitoring sodium levels is crucial to prevent complications. White blood cell count (Option A), albumin (Option B), and calcium (Option C) are not typically affected by prolonged NG suctioning. Therefore, these values are not the priority for monitoring in this situation.

2. A child is undergoing chemotherapy to treat a neuroblastoma, stage IV, and had his first chemotherapy session last week. He arrives with his mother for this week's session. How would the nurse greet the child?

• A. How did you feel after your last treatment?
• B. What are your thoughts on the treatment so far?
• C. Did you experience any side effects after the last session?
• D. Are you ready for the next round of treatment?

Correct answer: A

Rationale: The most appropriate way for the nurse to greet the child is by asking, 'How did you feel after your last treatment?' This question allows the child to share their experience voluntarily, empowering them to feel in control of the conversation. It also demonstrates empathy and a caring attitude. Option B, 'What are your thoughts on the treatment so far?' is broad and may not address the child's immediate feelings after the last session. Option C, 'Did you experience any side effects after the last session?' focuses solely on side effects and may predispose the child to think negatively. Option D, 'Are you ready for the next round of treatment?' does not address the child's current well-being or feelings, missing an opportunity for emotional support and connection.

3. A client who is to undergo dilation and curettage and conization of the cervix for cancer appears tense and anxious. Which approach would the nurse use to support the client emotionally?

• A. Explaining that these procedures are considered minor surgery
• B. Asking whether something is troubling the client and whether she'd like to talk about it
• C. Stating that the procedures are routine and asking what the client is really worried about
• D. Explaining that everyone is fearful before the surgery even though there is little reason to worry

Correct answer: B

Rationale: The correct approach for the nurse to support the client emotionally is to ask whether something is troubling the client and if she would like to talk about it. This approach acknowledges the client's anxiety and encourages communication without dismissing her feelings. Option A, explaining that the procedures are minor surgery, may invalidate the client's emotions. Option C assumes the client is worried about something specific, which may not be the case, leading to miscommunication. Option D provides false reassurance and may hinder open communication by dismissing the client's feelings as unwarranted.

4. Which statement best describes the pathophysiology of dementia of the Alzheimer type?

• A. There is a genetic predisposition and dysregulation of neurotransmitters.
• B. The dementia is transient and secondary to a physical imbalance or disorder.
• C. Hypoxia and decreased perfusion of select areas of the brain cause tissue damage.
• D. The presence of amyloid plaques is associated with brain tissue destruction.

Correct answer: D

Rationale: In Alzheimer's disease, the accumulation of amyloid plaques in the brain is a hallmark feature. These plaques are associated with the destruction of brain tissue, contributing to the cognitive decline seen in dementia. Genetic predisposition and dysregulation of neurotransmitters are factors linked to the development of Alzheimer's disease, but the primary pathology lies in the amyloid plaques. Transient dementia is not characteristic of Alzheimer's disease, which is a progressive neurodegenerative disorder. Hypoxia and decreased perfusion are more typical of vascular dementia, where blood flow to the brain is compromised.

5. A client has just died, and their son states, 'She was the most wonderful mother. There was no one who was a better mother than she was. She was perfect.' Which stage of grief is this son experiencing?

• A. Denial
• B. Anger
• C. Idealization
• D. Shock

Correct answer: C

Rationale: The son is experiencing the idealization stage of grief. During this stage, individuals tend to idealize the deceased person and remember them in a highly positive light, overlooking any negative aspects. This idealization serves as a coping mechanism to deal with the loss. Choice A, Denial, is incorrect as denial involves refusing to accept the reality of the loss. Choice B, Anger, is incorrect as it involves feelings of resentment and frustration. Choice D, Shock, is incorrect as shock is the initial reaction to the loss and is different from idealizing the deceased individual.

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