Nursing Elites

1. A client has been diagnosed with a form of terminal cancer and has started receiving hospice care. The nurse notes that both the client and his family avoid talking about the diagnosis. All attempts at discussion result in changing the subject. The nurse recognizes that this family is exhibiting:

• A. Closed awareness
• B. Mutual pretense
• C. Open awareness
• D. Powerless assessment

Correct answer: B

Rationale: The correct answer is 'Mutual pretense.' Mutual pretense is a form of awareness as a response to death or dying in which those involved avoid discussing the situation. In this scenario, both the client and the family are aware of the terminal cancer diagnosis, but they choose not to talk about it openly. This behavior can stem from various reasons, such as trying to shield loved ones from grief, fear of the future, or discomfort with discussing emotions. 'Closed awareness' (Choice A) refers to a lack of awareness of the impending death, which is not the case here. 'Open awareness' (Choice C) involves open acknowledgment and discussion of the terminal illness, which is contrary to the behavior described. 'Powerless assessment' (Choice D) does not relate to the situation of avoiding discussing the diagnosis in the context of terminal cancer and hospice care.

2. The primary health care provider tells a mother that her newborn has multiple visible birth defects. The mother seems composed and asks to see her baby. Which nursing action will be most helpful in easing the mother's stress when she sees her child for the first time?

• A. Bringing the infant as requested before she changes her mind
• B. Describing how the infant looks before bringing the infant to her
• C. Staying with her after bringing the infant to help her verbalize her feelings
• D. Showing the mother pictures of the birth defects, then bringing the infant to her

Correct answer: C

Rationale: Allowing the mother time to verbalize her feelings and providing support when she sees her newborn with birth defects for the first time is crucial. Staying with her allows for immediate emotional support, acceptance, and understanding, which can help ease her stress. Bringing the infant as requested without proper emotional support may overwhelm the mother. Describing the infant's appearance before she sees the baby might not be accurate and could add to her distress. Showing pictures of the birth defects before the mother sees her baby may not be helpful and could increase her anxiety. Engaging in discussions about treatment at this point may be premature and overwhelming for the mother.

3. Which activity would be most beneficial for a school-age client diagnosed with a chronic illness to enhance a sense of accomplishment?

• A. Wearing make-up
• B. Making up missed work
• C. Participating in sports activities
• D. Participating in creative activities

Correct answer: B

Rationale: Making up missed work is an essential activity that can help a school-age client diagnosed with a chronic illness feel a sense of accomplishment. By catching up on missed work, the child can regain a sense of control and productivity, which can be empowering during a challenging time. Wearing make-up is more related to personal grooming and self-expression, which may not directly contribute to a sense of accomplishment in this context. Participating in sports activities is beneficial for peer relationships and physical health but may not address the immediate need for accomplishment in the academic setting. Engaging in creative activities fosters cognitive development but may not directly address the sense of achievement associated with completing academic tasks.

4. Based on Maslow's hierarchy of needs, which client is demonstrating characteristics of self-actualization?

• A. Client is competent and esteemed by others for accomplishing work goals
• B. Client maintains a stable, loving, same-sex partnership for several years
• C. Client learns to sublimate aggressive impulses using physical exercises
• D. Client has an accurate perception of reality and is accepting of self and others

Correct answer: D

Rationale: According to Maslow's hierarchy of needs, self-actualization is the highest level where individuals strive to reach their full potential and achieve personal growth. A self-actualized person, as per Maslow, has an accurate perception of reality and is accepting of themselves and others. This individual is characterized by traits such as fairness, independence, spontaneity, and creativity. While choices A, B, and C represent important aspects of human needs fulfillment, they align more closely with lower levels in Maslow's hierarchy. Choice A refers to meeting self-esteem needs, choice B relates to love and belonging needs, and choice C addresses safety needs, all of which are below self-actualization in the hierarchy of needs.

5. A client is being assessed by a nurse for increased anxiety, restlessness, and insomnia. Which of the following interventions is the first priority for the nurse?

• A. Administer anti-anxiety medications as prescribed by the healthcare provider
• B. Engage in a conversation with the client regarding methods to enhance rest and sleep
• C. Escort the client to a private room and stay with them
• D. Review the client's medical history to determine previous treatment for these issues

Correct answer: C

Rationale: The first priority when dealing with a client experiencing potential mental health issues is to ensure their safety. Taking the client to a private room helps to reduce external stimuli and staying with them ensures constant monitoring and support. This intervention can prevent any escalation of anxiety or restlessness and promote a sense of security for the client. Engaging in a conversation about improving rest and sleep is important but ensuring immediate safety takes precedence. Administering medications should only be done after the client's safety is assured. Reviewing the client's medical history, while important, is not the immediate priority when the client is exhibiting acute symptoms of anxiety and restlessness.

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