Nursing Elites

1. When a nurse assigned to a manipulative client for 5 days becomes aware of feelings of reluctance to interact with the client, what should be the next action by the nurse?

• A. Discuss the feeling of reluctance with an objective peer or supervisor
• B. Limit contact with the client to avoid reinforcement of the manipulative behavior
• C. Confront the client about the negative effects of behaviors on other clients and staff
• D. Develop a behavior modification plan that will promote more functional behavior

Correct answer: A

Rationale: The correct action for the nurse in this situation is to discuss the feeling of reluctance with an objective peer or supervisor. By doing so, the nurse can address their emotions professionally and seek guidance on how to manage the situation effectively. This approach allows the nurse to receive support and potentially gain insights on how to navigate interactions with the manipulative client. Option B is incorrect because avoiding the client may not address the underlying issues causing the reluctance and can impact the quality of care provided. Option C is inappropriate as confronting the client directly about negative behaviors may escalate the situation and harm the therapeutic relationship. Option D is not the immediate action needed in this scenario; it is essential to address the nurse's feelings first before considering behavior modification plans.

2. A nurse on a medical-surgical unit is dividing care for four clients. The nurse should identify which of the following situations as an ethical dilemma?

• A. A client who has a new colostomy refuses to take instructions from the ostomy therapist because she 'doesn't like him.'
• B. A surgeon who removed the wrong kidney during a surgical procedure refuses to take responsibility for her actions.
• C. The family of a client who has a terminal illness asks the provider not to tell the client the diagnosis.
• D. A client who has Crohn's disease reports that his prescription drug plan will not pay for his medications.

Correct answer: C

Rationale: The correct answer is C because an ethical dilemma involves conflicting moral principles. In this scenario, the family's request not to disclose the terminal diagnosis to the client raises the moral question of truth-telling and patient autonomy. Choice A does not present an ethical dilemma but rather a challenge in client compliance. Choice B involves professional responsibility and accountability, not an ethical dilemma. Choice D relates to financial concerns and insurance coverage, which do not constitute an ethical dilemma but rather a financial issue.

3. A nurse is calculating a client's fluid intake over the past 8 hr. Which of the following items should the nurse plan to document on the client's intake and output record as 120 mL of fluid?

• A. 2 cups of soup
• B. 1 quart of water
• C. 8 oz of ice chips
• D. 6 oz of tea

Correct answer: C

Rationale: The correct answer is C: 8 oz of ice chips. When calculating fluid intake, the nurse should document half of the volume of ice chips to account for the air in between the chips. Therefore, 8 oz of ice chips equals 120 mL of fluid. Choices A, B, and D are incorrect because they do not equate to 120 mL of fluid intake as per the given scenario. Choice A, 2 cups of soup, is more than 120 mL. Choice B, 1 quart of water, is significantly more than 120 mL. Choice D, 6 oz of tea, is less than 120 mL.

4. A client is grieving the loss of her partner and expresses thoughts of not seeing the point of living anymore. What action should the nurse take?

• A. Recommend that the client seek spiritual guidance
• B. Request additional support from the client's family
• C. Tell the client that this is a normal response to grief
• D. Ask the client if she plans to harm herself

Correct answer: D

Rationale: When a client expresses feelings of hopelessness or worthlessness, it is crucial for the nurse to assess for suicidal ideation. Asking the client directly if she plans to harm herself is essential to determine the level of risk and ensure appropriate interventions are implemented. Recommending spiritual guidance (Choice A) may not address the immediate safety concerns related to suicidal ideation. Requesting additional support from the client's family (Choice B) is not as direct in addressing the client's safety. While stating that the client's response is a normal part of grief (Choice C) may provide validation, it does not address the potential risk of harm to the client.

5. A client reports increased pain following physical therapy. Which of the following questions should be asked to assess the quality of the pain?

• A. Is your pain sharp or dull?
• B. Is your pain constant or intermittent?
• C. On a scale from 1 to 10, how severe is your pain?
• D. Where exactly is your pain located?

Correct answer: A

Rationale: Correct Answer: A. Asking whether the pain is sharp or dull helps in determining the quality of the pain. Sharp pain is often associated with acute conditions, while dull pain may indicate chronic issues. Choices B, C, and D focus on different aspects of pain assessment. Option B pertains to the pattern of pain, either constant or intermittent. Option C addresses the severity of pain on a numerical scale. Option D inquires about the location of pain. While all these questions are essential in pain assessment, when specifically evaluating the quality of pain, distinguishing between sharp and dull sensations is crucial.

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