Nursing Elites

1. A client tells the nurse that his wife's nagging really gets on his nerves. He asks the nurse to talk with her about her nagging during their family session tomorrow afternoon. Which of the following responses is the most therapeutic for the client?

• A. "Tell me more specifically about her complaints."?
• B. "Can you think of reasons why she might nag you so much?"?
• C. "I'll help you think about how to bring this up yourself tomorrow afternoon."?
• D. "Why do you want me to initiate this in tomorrow's session rather than you?"?

Correct answer: C

Rationale: The most therapeutic response is to empower the client to address the issue himself. By offering assistance in thinking about how to bring up the topic during the family session, the nurse is promoting the client's autonomy and communication skills. This response encourages the client to take an active role in resolving the situation. Choices A and B focus on the wife's behavior, which is not the immediate concern during this interaction. Choice D challenges the client's request and shifts the responsibility back to the client, potentially hindering progress and discouraging open communication.

2. Following the change of shift report, when can or should the nurse alter or modify the plan?

• A. halfway through the shift
• B. at the end of the shift before handing over
• C. when needs change
• D. after the top-priority tasks have been completed

Correct answer: C

Rationale: The correct answer is 'when needs change.' The nurse should be flexible and adjust the plan as necessary when the needs of the patients change. This ensures that care is provided effectively and efficiently. Choices A, B, and D are incorrect because altering the plan based on time intervals, solely at the end of the shift, or after completing top-priority tasks may not align with the current needs of the patients.

3. Which action by the novice nurse indicates a need for further teaching?

• A. The nurse fails to wear gloves when removing a dressing.
• B. The nurse applies an oxygen saturation monitor to the earlobe.
• C. The nurse elevates the head of the bed to check blood pressure.
• D. The nurse places the extremity in a dependent position to acquire a peripheral blood sample.

Correct answer: A

Rationale: The correct answer is A. The novice nurse failing to wear gloves when removing a dressing indicates a need for further teaching to emphasize infection control practices. This action can lead to the spread of infections. Choices B, C, and D are incorrect because they demonstrate proper nursing skills and techniques. Applying an oxygen saturation monitor to the earlobe, elevating the head of the bed to check blood pressure, and placing the extremity in a dependent position to acquire a peripheral blood sample all reflect understanding of correct procedures in patient care.

4. What significant event occurs in the orientation phase of a nurse-client relationship?

• A. establishment of roles
• B. identification of transference phenomenon
• C. placement of the client within their family structure
• D. client agreement that the nurse has the authority in the relationship

Correct answer: B

Rationale: In the orientation phase of a nurse-client relationship, the significant event is the identification of transference phenomenon. Transference phenomena are intensified in relationships with authority figures like nurses and physicians. Positive transferences may include a desire for affection and dependency, while negative transferences may involve hostility and competitiveness. It is crucial to recognize and address these transferences before progress and positive changes can be made in the working stage. The other choices are incorrect; the establishment of roles may occur in the working phase, placing the client within their family structure is not a key event in the orientation phase, and client agreement on the nurse's authority is not the primary focus during this phase.

5. A new nursing graduate indicates in charting entries that he is a licensed practical nurse, although he has not yet received the results of the licensing exam. The graduate's action can result in what type of charge?

• A. Fraud
• B. Tort
• C. Malpractice
• D. Negligence

Correct answer: A

Rationale: The correct answer is 'Fraud.' Identifying oneself as a nurse without a license defrauds the public and can lead to prosecution. A tort is a wrongful act in breach of a legal duty imposed by law; malpractice is the failure to act appropriately as a nurse or acting in a way that harm comes to the client; and negligence is failing to perform care. In this scenario, the key issue is the misrepresentation of licensure status, which constitutes fraud. Therefore, choices B, C, and D are incorrect.

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