Nursing Elites

1. Ashley and her boyfriend Chris, both 19 years old, are transported to the Emergency Department after being involved in a motorcycle accident. Chris is badly hurt, but Ashley has no apparent injuries, though she appears confused and has trouble focusing on what is going on around her. She complains of dizziness and nausea. Her pulse is rapid, and she is hyperventilating. The nurse should assess Ashley’s level of anxiety as:

• A. mild.
• B. moderate.
• C. severe.
• D. panic.

Correct answer: C: severe.

Rationale: Based on the symptoms described, Ashley's level of anxiety should be assessed as severe. In severe anxiety, individuals have difficulty solving problems and understanding their environment. They often exhibit somatic symptoms like dizziness, nausea, rapid pulse, and hyperventilation. In contrast, mild anxiety may lead to mild discomfort or even enhanced performance. Moderate anxiety involves grasping less information, mild difficulty in problem-solving, and slight changes in vital signs. Panic, on the other hand, is characterized by markedly disturbed behavior and a potential loss of touch with reality. Therefore, in Ashley's case, the presence of somatic symptoms and vital sign changes indicates severe anxiety.

2. Which laboratory test would be the least effective in diagnosing a myocardial infarction?

• A. AST
• B. Troponin
• C. CK-MB
• D. Myoglobin

Correct answer: A: AST

Rationale: AST, choice A, would be the least effective in diagnosing a myocardial infarction as it is not specific for this condition. Troponin, CK-MB, and myoglobin (choices B, C, and D) are more specific markers for myocardial infarction. Troponin is considered the gold standard due to its cardiac specificity. CK-MB is also specific to the heart, and its isoenzyme levels elevate post-heart damage. Myoglobin, although elevated in myocardial infarction, is not as specific as troponin and CK-MB and can also increase in conditions like burns and muscle trauma. Therefore, AST is the least effective choice for diagnosing a myocardial infarction.

3. In performing a psychosocial assessment, the nurse begins by asking questions that encourage the client to describe problematic behaviors and situations. The next step is to elicit the client’s

• A. feelings about what has been described.
• B. thoughts about what has been described.
• C. possible solutions to the problem.
• D. intent in sharing the description.

Correct answer: thoughts about what has been described.

Rationale: In performing a psychosocial assessment, the nurse follows a structured approach, starting with encouraging the client to describe problematic behaviors and situations. The next step is to elicit the client’s thoughts about what has been described. This step helps gather more assessment data and understand how the client interprets the situation. Asking about feelings, exploring possible solutions, and understanding the client's intent in sharing the description are more complex processes that come later in the assessment. Therefore, the correct next step after describing behaviors and situations is to inquire about the client's thoughts.

4. The nurse is caring for a dying client who has persistently requested that the nurse 'help her to die and be in peace.' According to the Code of Ethics for Nurses, the nurse should:

• A. Ask the client if she has signed an advance directives document.
• B. Tell the client that another nurse will be assigned to care for her.
• C. Instruct the client that only a physician can legally assist in suicide.
• D. Try to make the client as comfortable as possible, but refuse to assist in death.

Correct answer: Try to make the client as comfortable as possible, but refuse to assist in death.

Rationale: According to the Code of Ethics for Nurses, the nurse should try to make the client as comfortable as possible but refuse to assist in death. It is not within the scope of nursing practice to assist in death, even if requested by the client. Choice A is incorrect as advance directives do not directly relate to the client's request for assistance in dying. Choice B is inappropriate as passing the responsibility to another nurse does not address the ethical dilemma at hand. Choice C is incorrect because instructing the client that only a physician can legally assist in suicide does not address the ethical considerations involved in the request. Therefore, the most appropriate action for the nurse is to provide comfort measures while upholding ethical standards and not participating in ending the client's life.

5. When planning care of a client who has been diagnosed with Amphetamine Abuse, the nurse should use the knowledge that:

• A. Amphetamines increase energy by increasing dopamine levels at neural synapses.
• B. Amphetamines have a low risk of tolerance or addiction.
• C. Amphetamines produce a 10–20-second rush followed by a 2–4-hour high.
• D. Addiction to barbiturates and amphetamines is rare because they have opposite effects.

Correct answer: Amphetamines increase energy by increasing dopamine levels at neural synapses.

Rationale: The correct answer is that amphetamines increase energy by increasing dopamine levels at neural synapses. Amphetamines cause the release of norepinephrine and dopamine from storage vesicles into the synapse, leading to increased stimulation. It is important to note that clear patterns of tolerance and withdrawal have not been described with amphetamines. Choice B is incorrect as prolonged or excessive use of amphetamines can lead to psychosis, indicating a potential for addiction. Choice C is incorrect as the duration of the effects of amphetamines is typically longer than 2-4 hours. Choice D is incorrect as addiction to amphetamines is not rare; in fact, drug cravings are common and can lead to relapse, indicating a significant risk of addiction.

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