Nursing Elites

1. A nurse is caring for a client with a diagnosis of terminal cancer. Which of the following statements by the client should indicate to the nurse that the client is ready to hear information regarding palliative care?

• A. "I am ready to learn about chemotherapy to help cure my cancer."
• B. "I just want you to give me something to get this over with soon."
• C. "I want you to tell me about measures available to keep me comfortable."
• D. "I know that many people have recovered fully from cancer, and so will I."

Correct answer: C

Rationale: Choice C is the correct answer because the client expressing a desire to know about measures available to keep comfortable indicates readiness for palliative care. Palliative care focuses on providing comfort, symptom management, and improving the quality of life for patients with serious illnesses such as terminal cancer. Choices A, B, and D are incorrect. Choice A indicates a desire for chemotherapy to cure the cancer, which does not align with palliative care goals. Choice B expresses a wish to end the situation quickly, which may not be in line with palliative care that focuses on comfort and quality of life. Choice D shows optimism about a full recovery, which may not be realistic for a client with terminal cancer who needs palliative care.

2. A technique used to eliminate negative behavior by ignoring the behavior is known as __________.

• A. Punishment
• B. Extinction
• C. Shaping
• D. Equity

Correct answer: B

Rationale: The correct answer is B, 'Extinction.' Extinction is a behavioral psychology technique where undesirable behavior is ignored, leading to its eventual decrease or elimination. This process involves withholding reinforcement that was previously maintaining the behavior. Choice A, 'Punishment,' involves applying negative consequences to reduce unwanted behavior, which is different from extinction. Choice C, 'Shaping,' is a method of gradually molding or reinforcing behaviors to reach a desired behavior, not ignoring negative behavior. Choice D, 'Equity,' refers to fairness and equal treatment, which is unrelated to eliminating negative behavior through ignoring it.

3. A nurse is caring for a client who reports difficulty falling asleep. Which of the following recommendations should the nurse make?

• A. Watch a television program in bed before going to sleep.
• B. Drink a cup of hot cocoa before bedtime.
• C. Maintain a consistent time to wake up each day.
• D. Exercise 1 hour before going to bed.

Correct answer: C

Rationale: The correct answer is C: "Maintain a consistent time to wake up each day." Establishing a regular wake-up time helps regulate the body's internal clock and promotes better sleep patterns. Watching television in bed (Choice A) can actually hinder sleep due to the light emitted by screens affecting melatonin production. Drinking beverages with caffeine like hot cocoa (Choice B) close to bedtime can interfere with falling asleep. Exercising vigorously right before bed (Choice D) can increase alertness and make it harder to fall asleep.

4. When a patient with type 2 diabetes is admitted for a cholecystectomy, which nursing action can the nurse delegate to a licensed practical/vocational nurse (LPN/LVN)?

• A. Communicate the blood glucose level and insulin dose to the circulating nurse in surgery.
• B. Discuss the reason for the use of insulin therapy during the immediate postoperative period.
• C. Administer the prescribed lispro (Humalog) insulin before transporting the patient to surgery.
• D. Plan strategies to minimize the risk for hypoglycemia or hyperglycemia during the postoperative period.

Correct answer: C

Rationale: The correct answer is C because the administration of prescribed lispro (Humalog) insulin before transporting the patient to surgery is a task that can be safely delegated to a licensed practical/vocational nurse (LPN/LVN). This action is within the scope of practice of an LPN/LVN and does not require independent nursing judgment. Choices A and B involve communicating and discussing important medical information, which are higher-level nursing actions typically performed by registered nurses. Choice D involves planning strategies to manage blood glucose levels postoperatively, which requires critical thinking and assessment skills usually performed by a registered nurse.

5. The nurse is taking a health history from a 29-year-old pregnant patient at the first prenatal visit. The patient reports no personal history of diabetes but has a parent who is diabetic. Which action will the nurse plan to take first?

• A. Teach the patient about administering regular insulin.
• B. Schedule the patient for a fasting blood glucose level.
• C. Discuss an oral glucose tolerance test for the twenty-fourth week of pregnancy.
• D. Provide teaching about an increased risk for fetal problems with gestational diabetes.

Correct answer: B

Rationale: The correct answer is B. Given the family history of diabetes, the initial action the nurse should take is to schedule the patient for a fasting blood glucose level. This will help in assessing if the patient has developed gestational diabetes. Choice A is incorrect because teaching about administering regular insulin is premature without confirming the diagnosis. Choice C is incorrect as an oral glucose tolerance test is typically done earlier in pregnancy. Choice D is incorrect as discussing fetal problems related to gestational diabetes should come after a confirmed diagnosis.

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