Nursing Elites

1. A home health nurse is making preparations for morning visits. Which one of the following clients should the nurse visit first?

• A. A client with brain attack (stroke) receiving tube feedings
• B. A client with congestive heart failure complaining of nighttime dyspnea
• C. A client who had a thoracotomy 6 months ago
• D. A client with Parkinson’s disease

Correct answer: B

Rationale: The correct answer is B. The client with congestive heart failure complaining of nighttime dyspnea should be seen first as airway management is a priority in nursing care. This client's symptoms indicate potential respiratory distress, requiring immediate attention. Choices A, C, and D involve clients who are more stable and do not present with urgent or acute conditions that require immediate intervention. Choice A with a client receiving tube feedings for a stroke may require attention, but the urgency of addressing potential respiratory distress in choice B takes precedence. Choice C, a client who had a thoracotomy 6 months ago, unless presenting with acute distress, does not necessitate immediate attention. Choice D, a client with Parkinson's disease, is usually a chronic condition that does not typically require immediate intervention for the described scenario.

2. Support-system enhancement includes all of the following except:

• A. determining the barriers to using support systems.
• B. discussing ways to help others who are concerned.
• C. exploring life problems of the support-team members.
• D. involving spouse, family, and friends in the care and planning.

Correct answer: C

Rationale: Support-system enhancement involves various strategies to strengthen the support system. Determining the barriers to using support systems, discussing ways to help others who are concerned, and involving spouse, family, and friends in the care and planning are all essential aspects of enhancing the support system. However, exploring the life problems of the support-team members is not directly related to enhancing the support system. This approach could potentially invade personal boundaries and may not be necessary for improving the support system, making it the correct answer in this case. Therefore, option C is the correct answer as it does not align with the appropriate methods of support-system enhancement.

3. The nurse who was not promoted then went to the utility room and slammed several cupboard doors while looking for Kleenex. This behavior exemplifies:

• A. displacement.
• B. sublimation
• C. conversion.
• D. reaction formation.

Correct answer: A.

Rationale: Displacement unconsciously transfers emotions associated with a person, object, or situation to another less threatening person, object, or situation. In this scenario, the nurse slammed doors instead of expressing anger towards the promoted nurse or the administrator who made the promotion decision. Sublimation is the unconscious process of substituting constructive activity for unacceptable impulses. Since slamming cupboard doors is not a constructive activity, this choice is incorrect. Conversion involves transforming anxiety into physical symptoms, which is not demonstrated in the given behavior. Reaction formation keeps unacceptable feelings or behaviors out of awareness by displaying the opposite feeling or behavior, which is not the case here.

4. If the client is receiving peritoneal dialysis and the dialysate returns cloudy, what should the nurse do?

• A. Document the finding
• B. Send a specimen to the lab
• C. Strain the dialysate
• D. Obtain a complete blood count

Correct answer: B

Rationale: When the dialysate returns cloudy, it could indicate the presence of infection, and sending a specimen to the lab for evaluation is crucial to determine the cause. Documenting the finding alone, as in choice A, may not provide enough information for proper intervention. Straining the dialysate, as in choice C, is not a standard practice and may not help identify the underlying issue. Obtaining a complete blood count, as in choice D, is not directly related to addressing cloudiness in the dialysate. However, the healthcare provider might order a white blood cell count to assess for infection.

5. The women's health charge nurse is making assignments for the next shift. The unit is short one staff member and will receive a nurse from the medical-surgical unit. Which group of clients should she assign to the medical-surgical nurse?

• A. Total abdominal hysterectomy, bladder suspension with A&P repair, client with breast reduction
• B. C-section planning discharge, post-partum infection, mastectomy
• C. Vaginal delivery of fetal demise, C-section with pneumonia, 32-week gestation with lymphoma
• D. 28-week gestation of bed rest, post-partum with HELLP syndrome, breast reconstruction

Correct answer: A

Rationale: The correct answer includes clients who have undergone surgical procedures typically managed on a medical-surgical unit. Choice A consists of clients who have had elective surgical procedures such as hysterectomy, bladder suspension with A&P repair, and breast reduction, which are commonly treated in a medical-surgical setting. Choices B, C, and D involve clients with various complications related to childbirth, fetal demise, pneumonia, gestational lymphoma, HELLP syndrome, and bed rest, which are more complex cases requiring specialized care beyond medical-surgical nursing.

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