Nursing Elites

1. A client who just had a bilateral mastectomy is preparing to talk about body changes. Which of the following actions of the nurse is most appropriate during this discussion?

• A. Provide a room that offers minimal distractions
• B. Ask closed-ended questions to allow the client to think about her situation
• C. Write detailed notes during the conversation to track important information
• D. Ask personal questions about the client's background to determine how the procedure has affected her self-concept

Correct answer: A

Rationale: When preparing to discuss sensitive topics such as body changes post-bilateral mastectomy, it is crucial to create a conducive environment. Providing a room with minimal distractions allows the client to feel comfortable, safe, and more likely to open up about personal feelings without interruptions. This setting fosters open communication between the nurse and client, facilitating a more empathetic and supportive interaction. Closed-ended questions (Choice B) may limit the client's ability to express emotions fully. Writing detailed notes (Choice C) during the conversation may distract the nurse from actively listening and being present for the client. Asking personal questions about the client's background (Choice D) may not be appropriate during such a vulnerable discussion and could potentially create discomfort for the client.

2. A client who has been told she needs a hysterectomy for cervical cancer reports being upset about being unable to have a third child. Which action would the nurse take?

• A. Evaluate her willingness to pursue adoption.
• B. Encourage her to focus on her own recovery.
• C. Emphasize that she does have two children already.
• D. Ensure that other treatment options for her are explored.

Correct answer: D

Rationale: In this scenario, the nurse should ensure that other treatment options for the client are explored. While a hysterectomy may be necessary for cervical cancer, conservative management options like cervical conization and laser treatment may allow for future pregnancies. It is crucial for the nurse to inform the client of all available treatment choices. Evaluating the client's willingness to pursue adoption is not directly addressing the client's concerns about fertility. Encouraging the client to focus on her own recovery and emphasizing that she already has two children dismiss the client's distress over not being able to have a third child, which is important to acknowledge in a sensitive manner.

3. When a man with dementia is admitted to a long-term care facility, his wife, who appears tired and angry, says in a sarcastic tone, 'Let's see what you can do with him.' Which response is therapeutic?

• A. It sounds like it's been difficult for you.'
• B. I don't understand what you mean.'
• C. 'I have experience with all types of clients.'
• D. It's too bad you didn't admit him sooner.'

Correct answer: A

Rationale: The correct response is to acknowledge the caregiver's feelings and challenges without blaming them. Option A, 'It sounds like it's been difficult for you,' shows empathy and opens the channel of communication. Options B and C, 'I don't understand what you mean' and 'I have experience with all types of clients,' are nurse-focused responses that block effective communication. Option D, 'It's too bad you didn't admit him sooner,' is a hostile response that shifts the blame to the caregiver, which is not therapeutic in this situation.

4. While obtaining a lie-sit-stand blood pressure reading on a client, what action is most important for the nurse to implement?

• A. Stay with the client while the client is standing.
• B. Record the findings on the graphic sheet in the chart.
• C. Keep the blood pressure cuff on the same arm.
• D. Record changes in the client's pulse rate.

Correct answer: A

Rationale: The most crucial action for the nurse to implement when obtaining a lie-sit-stand blood pressure reading is to stay with the client while the client is standing. This is essential to monitor the client's immediate response to position changes and ensure their safety. Recording the findings on the graphic sheet is important for documentation but is not as critical as staying with the client. Keeping the blood pressure cuff on the same arm helps maintain consistency in readings but is not as vital as ensuring client safety. Recording changes in the client's pulse rate is important for a comprehensive assessment but does not take precedence over monitoring the client during position changes.

5. When performing a return demonstration of using a gait belt for a female patient with right-sided weakness, which observation indicates that the caregiver has learned the correct procedure?

• A. Standing on the female patient's strong side, the caregiver is ready to hold the gait belt if any evidence of weakness is observed.
• B. Standing on the female patient's weak side, the caregiver provides security by holding the gait belt from the back.
• C. Standing behind the female patient, the caregiver provides balance by holding both sides of the gait belt.
• D. Standing slightly in front and to the right of the female patient, the caregiver guides her forward by gently pulling on the gait belt.

Correct answer: B

Rationale: When assisting a patient with right-sided weakness using a gait belt, the caregiver must stand on the weak side of the patient to provide optimal support and security. By standing on the weak side and holding the gait belt from the back, the caregiver can effectively prevent falls and guide the patient's movements. This position allows for better control over the patient's balance. Standing on the strong side (option A) does not offer the necessary support if the patient leans towards the weak side. Standing behind the patient and holding both sides of the gait belt (option C) does not provide focused support to the weak side. Standing slightly in front and to the right (option D) may not offer adequate assistance to prevent falls on the weak side, making it an incorrect choice.

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