Nursing Elites

1. A client with generalized anxiety disorder presents with restlessness and fatigue. Which additional clinical manifestation would the nurse monitor for?

• A. Hoarding
• B. Panic attacks
• C. Excessive worry
• D. Fear of leaving the house

Correct answer: C

Rationale: The nurse would monitor for excessive worry. Generalized anxiety disorder is characterized by physical and cognitive symptoms of chronic or excessive anxiety and worry. Excessive worry is a core feature of generalized anxiety disorder. Hoarding is a symptom of hoarding disorder, not generalized anxiety disorder. Panic attacks are typical of panic disorder, not generalized anxiety disorder. Fear of leaving the house is a characteristic of agoraphobia, which is distinct from generalized anxiety disorder.

2. While reviewing the side effects of a newly prescribed medication, a 72-year-old client notes that one of the side effects is a reduction in sexual drive. Which is the best response by the nurse?

• A. How will this affect your present sexual activity?
• B. How active is your current sex life?
• C. How has your sex life changed as you have become older?
• D. Tell me about your sexual needs as an older adult.

Correct answer: A

Rationale: The best response in this scenario is option A, 'How will this affect your present sexual activity?' This response directly addresses the client's concern and allows them to express their thoughts and feelings. Option B does not directly address the client's worry about the medication's side effect. Options C and D deviate from the client's immediate concern and are not as relevant in this situation.

3. What step should be taken when administering ear drops to an adult client?

• A. Place the client in a side-lying position.
• B. Hold the dropper 1 cm above the ear canal.
• C. Place a cotton ball into the outermost canal.
• D. Pull the auricle down and back.

Correct answer: A

Rationale: The correct step when administering ear drops to an adult client is to place the client in a side-lying position (A). This position allows for easier administration of the drops and helps prevent spillage. The dropper should be held approximately 1 cm (� inch) above the ear canal (B) to ensure accurate delivery of the medication. Placing a cotton ball into the outermost canal (C) is unnecessary and may interfere with the absorption of the ear drops. Pulling the auricle down and back (D) is a technique used for children younger than 3 years old to straighten the ear canal, but it is not necessary for adults and may cause discomfort.

4. A client states that she is angry and feels rejected by her boyfriend. Which action would the nurse encourage?

• A. Call the boyfriend to work things out.
• B. Avoid confronting the boyfriend.
• C. Date new people whenever possible.
• D. Learn to constructively vent anger.

Correct answer: D

Rationale: The correct answer is to encourage the client to learn to constructively vent anger. Coping mechanisms, such as venting anger, can help the client address feelings of rejection. Calling the boyfriend to work things out is offering unsolicited advice and may not be effective in managing emotions. Avoiding confronting the boyfriend may reduce anxiety temporarily but will not assist in resolving the underlying issues. Encouraging the client to date new people whenever possible is not appropriate at this stage, as it is essential for the client to work through the current crisis before considering new relationships.

5. 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.

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