Nursing Elites

1. During a well-baby check of a 6-month-old infant, the nurse notes abrasions and petechiae of the palate. The nurse should:

• A. inquire about the possibility of sexual abuse.
• B. ask about the types of foods the child is eating.
• C. request to see the type of bottle used for feedings.
• D. question the parent about objects the child plays with.

Correct answer: A

Rationale: The correct answer is to inquire about the possibility of sexual abuse. Injuries to the soft palate such as bruising, abrasions, and petechiae can be signs of sexual abuse in infants. While oral sex may not leave significant physical evidence, these findings should raise suspicion. Option A is correct as it focuses on addressing potential abuse. Options B, C, and D are incorrect because the child's diet, the type of bottle used for feedings, and play objects are not likely related to the observed injuries. The presence of oral injuries suggests considering sexual abuse rather than other factors.

2. The client is being assessed for possible pernicious anemia. Which finding would support this diagnosis?

• A. A weight loss of 10 pounds in 2 weeks
• B. Complaints of numbness and tingling in the extremities
• C. A red, beefy tongue
• D. A hemoglobin level of 12.0 g/dL

Correct answer: C

Rationale: The correct answer is a red, beefy tongue, which is characteristic of pernicious anemia due to the atrophy of the papillae on the tongue. This finding is known as glossitis. A red, beefy tongue is a classic sign of pernicious anemia. Choice A, weight loss of 10 pounds in 2 weeks, is non-specific and not a typical finding in pernicious anemia. Choice B, complaints of numbness and tingling in the extremities, are more indicative of peripheral neuropathy, a common symptom of vitamin B12 deficiency, which can be seen in pernicious anemia. Choice D, a hemoglobin level of 12.0 g/dL, falls within the normal range and does not specifically point towards pernicious anemia, which is characterized by low hemoglobin levels due to impaired absorption of vitamin B12.

3. The Token Economy is a type of therapy that focuses on:

• A. play therapy
• B. behavior modification
• C. milieu therapy
• D. associative

Correct answer: B

Rationale: The correct answer is 'behavior modification.' The Token Economy is a form of behavior modification that involves providing positive reinforcement in the form of tokens or rewards for desired behaviors. This approach aims to increase the occurrence of positive behaviors by rewarding them. Play therapy (choice A) focuses on using play as a medium for therapeutic communication, not specifically behavior modification. Milieu therapy (choice C) involves shaping the environment to promote desired behaviors but is not the primary focus of the Token Economy. 'Associative' (choice D) is not directly related to the Token Economy or its focus on behavior modification, making it an incorrect choice.

4. In the context of milieu therapy, what is its primary purpose?

• A. exploring the client's perception of reality
• B. enhancing social interaction abilities
• C. addressing maladaptive behaviors
• D. providing routine daily experiences

Correct answer: D

Rationale: Milieu therapy aims to provide routine daily experiences to clients. By offering a structured and predictable environment, it helps individuals feel safe and secure, reducing disruptive behaviors. Exploring the client's perception of reality (choice A) may be part of therapy but not the primary focus. Enhancing social interaction abilities (choice B) and addressing maladaptive behaviors (choice C) are important aspects of therapy but not the primary purpose of milieu therapy.

5. When discussing the patterns of use of alcohol and other drugs, which piece of information should the nurse include?

• A. Lifetime prevalence and intensity of alcohol use are greater in men than in women.
• B. Caucasians report higher levels of alcohol use than African Americans or Hispanics.
• C. Overuse of alcohol and other drugs increases into the mid-20s, then levels off and decreases with age.
• D. Heavy use is more common in lower socioeconomic groups due to affordability.

Correct answer: C

Rationale: The correct answer is that overuse of alcohol and other drugs increases into the mid-20s, then levels off and decreases with age. Recent research indicates that alcohol and illicit drug use tends to rise into the mid-20s and then decline with age. Choices A and B are incorrect because lifetime prevalence and intensity of alcohol use are greater in men than in women, and Caucasians do not report higher levels of alcohol use compared to African Americans or Hispanics. Choice D is incorrect because heavy use is more common in lower socioeconomic groups due to factors like stress, coping mechanisms, and availability, not just affordability.

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