Nursing Elites

1. A 30-year-old woman is scheduled for a total abdominal hysterectomy due to noninvasive endometrial cancer. The nurse anticipates the client may have difficulty adjusting emotionally to this type of surgery. Which concern would be the cause of this anticipated difficulty?

• A. Change in femininity
• B. Body image changes
• C. Diminished sexual desire
• D. Slow recovery

Correct answer: A

Rationale: The correct answer is 'Change in femininity.' The removal of the uterus can lead to changes in how some women perceive themselves sexually as it is a reproductive organ. In this young client, there may be heightened feelings of loss of femininity and reproductive potential. Body image changes could occur but are more likely with surgeries involving obvious external changes. Diminished sexual desire is unlikely in a premenopausal woman unless she has specific concerns. Slow recovery is not expected in an otherwise healthy 30-year-old woman undergoing this surgery.

2. The nurse is caring for a newly admitted patient. Which intervention is the best example of a culturally appropriate nursing intervention?

• A. Insist that family members provide most of the patient's personal care.
• B. Maintain a personal space of at least 2 feet when assessing the patient.
• C. Ask permission before touching a patient during the physical assessment.
• D. Consider the patient's ethnicity as an important factor in planning care.

Correct answer: C

Rationale: Culturally appropriate nursing care requires sensitivity to the beliefs and practices of diverse cultural groups. Asking permission before touching a patient during a physical assessment is a universally respectful practice, as many cultures consider it disrespectful to touch a person without consent. This approach demonstrates respect for the patient's autonomy and cultural preferences. Maintaining a personal space of at least 2 feet can be a good practice for infection control or personal comfort but may not be culturally significant for all patients. Insisting that family members provide most of the patient's personal care may not align with the patient's cultural norms or preferences. Considering a patient's ethnicity as the most important factor in care planning overlooks the individuality of the patient and may lead to stereotyping or assumptions that are not accurate or helpful in providing tailored care.

3. Which statement by an 8-year-old girl, who was just admitted to the hospital, needs to be explored?

• A. ''Wow! This hospital has bright colors.''
• B. ''Is my mother allowed to visit me tonight?'
• C. ''Those boys are so cute. I hope their room is next to mine!'
• D. ''I'm scared about being here. Can you stay with me awhile?'

Correct answer: C

Rationale: The correct answer is C. An 8-year-old child showing a strong attraction to boys at this age may raise concerns about precocious sexual behavior or exposure to inappropriate sexual content, potentially signaling the need to investigate for possible sexual abuse. It is important to explore this statement further. Choice A, expressing admiration for bright colors, is a common behavior for children of this age and does not raise immediate concerns. Choice B, inquiring about the mother's visit, is a typical concern for a hospitalized child seeking comfort and support. Choice D, expressing fear and seeking reassurance from the nurse, is also a normal reaction for an 8-year-old in a new and possibly intimidating environment. However, the statement in Choice C stands out as it deviates from age-appropriate behavior and warrants further exploration to ensure the child's safety and well-being.

4. Which of the following actions is most appropriate when working with a client who is extremely angry?

• A. Place a light hand on the client's shoulder to convey understanding
• B. Maintain close proximity to build trust
• C. Temporarily change the subject if the client's behavior is escalating
• D. Close the door to the room to ensure privacy

Correct answer: C

Rationale: When dealing with an angry client, it is crucial to employ techniques that can help de-escalate the situation or ensure safety while providing care. If the client's behavior is escalating or they are fixating on a particular topic that is fueling their anger, it is advisable to temporarily change the subject. This technique can serve as a distraction from the initial trigger, allowing the client to refocus their thoughts and emotions. Placing a hand on the client's shoulder may not be well-received as physical touch can escalate the situation. Maintaining close proximity might be perceived as confrontational rather than building trust. Closing the door for privacy is important but may not directly address the client's anger or help in de-escalation.

5. Which of the following best describes Eye Movement Desensitization and Reprocessing (EMDR)?

• A. A client follows the therapist's finger with their eyes while focusing on a negative thought or memory
• B. A client reads a story about a traumatic event and then visualizes the result
• C. A client focuses on a negative thought in their mind while tapping their fingers
• D. None of the above

Correct answer: A

Rationale: Eye Movement Desensitization and Reprocessing (EMDR) is a therapeutic approach used to address negative thoughts or traumatic memories, particularly in individuals with post-traumatic stress disorder. During EMDR, the client concentrates on a distressing thought or memory and the associated emotions while engaging in bilateral stimulation, often by moving their eyes back and forth. This bilateral stimulation can involve tracking the therapist's finger or other forms of sensory stimulation. Choice A is correct as it accurately describes the core process of EMDR. Choices B and C are incorrect as they do not involve the essential components of EMDR, which include eye movements or bilateral stimulation. Choice D is incorrect as EMDR is a specific therapeutic technique and not covered by selecting 'None of the above'.

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