Nursing Elites

1. A family member of a client with a diagnosis of Schizophrenia asks about the prognosis. The nurse's response is based on the knowledge that schizophrenia:

• A. affects both genders equally.
• B. is a chronic, deteriorating disease with periods of remission.
• C. is usually diagnosed in early adulthood.
• D. does not have a clear protective hormone effect delaying diagnosis.

Correct answer: B

Rationale: The correct answer is B: 'is a chronic, deteriorating disease with periods of remission.' While choices A, C, and D contain some truths about schizophrenia, they do not directly address the prognosis aspect of the question. Schizophrenia can affect both men and women equally, is typically diagnosed in early adulthood, and does not have a known protective hormone effect that delays diagnosis. Choice B accurately reflects the chronic and fluctuating nature of the disease, which is essential for understanding its long-term course.

2. A 6-year-old with cerebral palsy functions at the level of an 18-month-old. Which finding would support that assessment?

• A. She dresses herself
• B. She pulls a toy behind her
• C. She can build a tower of eight blocks
• D. She can copy a horizontal or vertical line

Correct answer: B

Rationale: The correct answer is 'She pulls a toy behind her.' This behavior is consistent with the developmental stage of an 18-month-old who enjoys push-pull toys. Dressing oneself usually begins around 3 years old, building a tower of eight blocks at approximately 3 years old, and copying a horizontal or vertical line at about 4 years old. Choices A, C, and D are incorrect as they represent skills that are typically observed in older children.

3. A mother has just given birth to a baby who died soon after. The mother has been crying and states, "I can't believe this has happened to me. I did everything right during this pregnancy."? How should the nurse respond to this mother?

• A. Tell her she did nothing wrong; it was God's will.
• B. Tell her she can have another baby.
• C. Tell her that her behavior is not going to solve anything.
• D. Tell her nothing and let her mourn this loss in the manner she chooses.

Correct answer: D

Rationale: Perinatal loss is a significant tragedy for parents, and it is crucial to provide sensitive and compassionate care. When a mother expresses her disbelief and feelings of doing everything right during the pregnancy, it is important for the nurse to acknowledge her pain and allow her to grieve in her way. Telling her that she did nothing wrong and it was God's will (Choice A) may not be comforting and can come across as dismissive of her feelings. Suggesting she can have another baby (Choice B) is insensitive and overlooks the grief she is experiencing for the current loss. Telling her that her behavior is not going to solve anything (Choice C) is invalidating her emotions and not supportive in this situation. Therefore, the best approach is to support her in her mourning process by respecting her feelings and allowing her to express her grief as she sees fit.

4. A 10-month-old child is brought to the Emergency Department because he is difficult to awaken. The nurse notes bruises on both upper arms. These findings are most consistent with:

• A. wearing clothing that is too small for the child.
• B. the child being shaken.
• C. falling while learning to walk.
• D. parents trying to awaken the child.

Correct answer: B

Rationale: The correct answer is 'the child being shaken.' In cases of suspected child abuse, bruises on both upper arms can be indicative of a child being shaken, as children who are shaken are frequently grasped by both upper arms. The presentation of a 10-month-old child being difficult to awaken, along with bruises on the upper arms, raises concern for inflicted injury. Symptoms of brain injury associated with shaking include a decreased level of consciousness. Choices A, C, and D are less likely in this scenario as they do not align with the concerning signs of suspected abuse indicated by the bruises and the child's altered level of consciousness.

5. A twenty-one-year-old man suffered a concussion, and the MD ordered an MRI. The patient asks, 'Will they allow me to sit up during the MRI?' The correct response by the nurse should be:

• A. "I will have to talk to the doctor about letting you sit upright during the test."?
• B. "You will be positioned in the reverse Trendelenburg position to maximize the view of the brain."?
• C. "The radiologist will let you know."?
• D. "You will have to lie down on your back during the test."?

Correct answer: D

Rationale: The correct answer is to inform the patient that they will have to lie down on their back during the MRI. This positioning is necessary for the scan to obtain accurate images of the brain. Choice A is incorrect because the decision on the positioning during the MRI is typically determined by the imaging protocol and not subject to negotiation during the test. Choice B is incorrect as the reverse Trendelenburg position is not commonly used during MRI scans. Choice C is incorrect because the radiologist does not usually make decisions on patient positioning during the MRI; it is predetermined by the imaging requirements.

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