Nursing Elites

1. A client is having psychological counseling for problems communicating with his mother. Which model of stress is the most useful in reference to this stressor?

• A. Adaptation Model
• B. Stimulus-Based Model
• C. Transaction-Based Model
• D. Selye's Model of Stress

Correct answer: C

Rationale: The Transaction-Based Model, proposed by R.S. Lazarus, is the most relevant model of stress in the context of a client facing communication issues with his mother. This model takes into consideration individual differences and cognitive processes that occur between a stressor and the individual's response. It emphasizes the importance of how the individual perceives and interprets the stressor, incorporating mental and psychological components. In this scenario, the client's difficulties in communicating with his mother involve complex cognitive processes and individual perceptions, making the Transaction-Based Model the most suitable choice. The other options are not as relevant in this context: the Adaptation Model focuses on adjustment to stress over time, the Stimulus-Based Model emphasizes external factors as stressors, and Selye's Model of Stress mainly centers on the physiological response to stress.

2. Which medication should the nurse withhold if the client's blood pressure is 88/50?

• A. Rosuvastatin (Crestor)
• B. Enalapril (Vasotec)
• C. Digoxin (Lanoxin)
• D. Clopidogrel (Plavix)

Correct answer: B

Rationale: Enalapril (Vasotec) is the correct answer. It is an angiotensin-converting enzyme (ACE) inhibitor that can further lower blood pressure. Given that the client's blood pressure is already low at 88/50, administering Enalapril could exacerbate hypotension and compromise perfusion to vital organs. Rosuvastatin (Crestor), Digoxin (Lanoxin), and Clopidogrel (Plavix) are not contraindicated in the context of low blood pressure and may be administered safely.

3. A woman is in the active phase of labor. An external monitor has been applied, and a fetal heart deceleration of uniform shape is observed, beginning just as the contraction is underway and returning to the baseline at the end of the contraction. Which of the following nursing actions is most appropriate?

• A. Administer O2.
• B. Turn the client on her left side.
• C. Notify the physician.
• D. No action is necessary

Correct answer: D

Rationale: This scenario describes early deceleration due to head compression, which is a benign finding in labor. Early decelerations mirror the contractions and do not require any intervention as they are considered a normal response to fetal head compression. The fetal heart rate returns to baseline at the end of the contraction. In this case, the correct action is no action at the moment. Close monitoring of the mother and baby is essential, but immediate intervention is not required. Administering O2 (Choice A) or turning the client on her left side (Choice B) is not indicated for early decelerations. Notifying the physician (Choice C) is unnecessary for this type of deceleration.

4. A client goes to the Emergency Department with acute respiratory distress and the following arterial blood gases (ABGs): pH 7.35, PCO2 40 mmHg, PO2 63mmHg, HCO3 23, and oxygenation saturation (SAO2) 93%. Which of the following represents the best analysis of the etiology of these ABGs?

• A. tuberculosis (TB)
• B. pneumonia
• C. pleural effusion
• D. hypoxia

Correct answer: D

Rationale: A combined low PO2 and low SAO2 indicates hypoxia. The pH, PCO2, and HCO3 are normal. ABGs are not necessarily altered in TB or pleural effusion. In pneumonia, the PO2 and PCO2 might be low because hypoxia stimulates hyperventilation, but the best analysis in this case is hypoxia due to the combination of low PO2 and low SAO2.

5. A client who has a known history of cardiac problems and is still smoking enters the clinic complaining of sudden onset of sharp, stabbing pain that intensifies with a deep breath. The pain is occurring on only one side and can be isolated upon general assessment. The nurse concludes that this description is most likely caused by:

• A. pleurisy.
• B. pleural effusion.
• C. atelectasis.
• D. tuberculosis.

Correct answer: A

Rationale: Pleurisy is an inflammation of the pleura and is often accompanied by an abrupt onset of pain. Symptoms of pleurisy include sudden sharp, stabbing pain that is usually unilateral and localized to a specific portion of the chest. The pain can be exacerbated by deep breathing. In contrast, pleural effusion is characterized by fluid accumulation in the pleural space, not sharp pain. Atelectasis involves collapse or closure of a lung leading to reduced gas exchange, but it does not typically present with sharp, stabbing pain. Tuberculosis is a bacterial infection that can affect the lungs but does not typically manifest with sudden sharp pain exacerbated by deep breathing.

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