Nursing Elites

1. After giving birth to her third child, a client tearfully says to the nurse, 'How much more can I give of myself?' Which principle would the nurse consider in the care of any new mother?

• A. It is easier to adjust to the first child than to later ones.
• B. Feeling anger and resentment toward a child is pathological.
• C. Some parents experience feelings of being overwhelmed by multiple children.
• D. Parents usually have inborn feelings of love and acceptance of their children.

Correct answer: C

Rationale: A parent's feeling of being overwhelmed by multiple children is a normal response. It is vital to help parents realize this as a means of easing feelings of guilt and shame. The first child causes the greatest amount of adjustment in one's life. It is common for parents to feel anger and resentment toward their children at times due to the challenges of parenting. Stating that parents usually have inborn feelings of love and acceptance of their children is a false generalization and may not hold true for everyone. Therefore, the most appropriate principle for the nurse to consider in this situation is that some parents may experience feelings of being overwhelmed by multiple children.

2. Which of the following individuals is at the highest risk of suicide?

• A. An 80-year-old man who lost his wife last year
• B. A 36-year-old woman whose former neighbor committed suicide
• C. A 40-year-old married businessman
• D. A 46-year-old former alcoholic who has been sober for 12 years

Correct answer: A

Rationale: The correct answer is an 80-year-old man who lost his wife last year. Certain factors increase the risk of suicide, such as recent loss of a loved one, in this case, the man's wife. The elderly are a high-risk group due to factors like social isolation, physical health issues, and bereavement. While experiencing a loss can affect anyone, the combination of age, loss of a spouse, and the associated emotional impact elevates the risk significantly. The other choices are not at the highest risk of suicide. A former alcoholic who has been sober for 12 years has taken steps towards recovery, reducing the immediate risk. A 40-year-old married businessman and a 36-year-old woman whose former neighbor committed suicide do not have the same level of immediate risk as the elderly man who recently lost his wife.

3. Which of the following is an example of an opioid?

• A. Mescaline
• B. Diazepam
• C. Phenobarbital
• D. Methadone

Correct answer: D

Rationale: Opioids are a type of drug classified as narcotics. Nurses working with clients with substance abuse issues often encounter opioids. Opioids have the potential for addiction. Examples of opioids include methadone, codeine, morphine, and hydromorphone. Mescaline (Choice A) is a hallucinogen, not an opioid. Diazepam (Choice B) is a benzodiazepine used to treat anxiety and other conditions, not an opioid. Phenobarbital (Choice C) is a barbiturate used to treat seizures and insomnia, not an opioid.

4. Which approach would be most appropriate for the involved parent of a child diagnosed with Munchausen syndrome by proxy?

• A. Confrontation
• B. Open communication
• C. Health teaching about childrearing
• D. Validation of the child's physical status

Correct answer: B

Rationale: The most appropriate approach for the involved parent of a child diagnosed with Munchausen syndrome by proxy is open communication. Maintaining open communication is crucial in building a therapeutic nurse-client relationship. Confrontation may cause the parent to become defensive and hinder effective communication. Health teaching about childrearing may not be well-received at this point as the parent may not be ready for it. Validation of the child's physical status may inadvertently reinforce the parent's behavior by focusing solely on physical symptoms rather than addressing the underlying issues.

5. When bathing an uncircumcised boy older than 3 years, which action should the nurse take?

• A. Remind the child to clean his genital area.
• B. Defer perineal care because of the child's age.
• C. Retract the foreskin gently to cleanse the penis
• D. Ask the parents why the child is not circumcised

Correct answer: C

Rationale: When bathing an uncircumcised boy older than 3 years, it is essential to gently retract the foreskin to cleanse the penis. This helps in preventing the buildup of bacteria and maintaining good hygiene. Reminding the child to clean his genital area (Option A) may not be effective due to the child's cognitive development level. Perineal care should not be deferred (Option B) as it is necessary for maintaining hygiene at any age. Asking the parents why the child is not circumcised (Option D) is not relevant to the immediate care required during bathing.

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