Nursing Elites

1. During the first meeting of a therapy group, members exhibit frequent periods of silence, tense laughter, and nervous movements. Which conclusion would the nurse make?

• A. The group requires an active leader who will intervene to relieve signs of obvious stress.
• B. The group process is unhealthy and there is unwillingness to openly relate.
• C. The members are displaying expected behaviors because relationships are not yet established.
• D. The behaviors should be immediately addressed so members will not become too uncomfortable.

Correct answer: C

Rationale: During the initial stages of a therapy group, it is common for members to exhibit behaviors such as silence, tense laughter, and nervous movements. These behaviors indicate anxiety and insecurity due to the lack of established relationships and trust among the group members. This is a normal part of group development, and it does not necessarily mean that the group process is unhealthy. Intervening or addressing these behaviors immediately is not required as they are expected in the early stages of group interaction. As the group progresses and relationships are built, these behaviors are likely to diminish naturally without the need for active leader intervention. Therefore, the correct conclusion is that the members are displaying expected behaviors because relationships are not yet established. Choices A, B, and D are incorrect because active leader intervention is not necessary, the group process is not unhealthy, and addressing the behaviors immediately is not required as they are part of the early group dynamics and are expected to subside as relationships develop.

2. Which response would the nurse provide to a client in labor at 32 weeks' gestation who tells the nurse that she and her husband are very concerned because the baby will be born 2 months early?

• A. ''You should be concerned. I feel for you.''
• B. 'If you're concerned, let's talk about it.''
• C. ''Try not to worry about it; just concentrate on your labor.''
• D. 'Don't worry; the care of preterm babies has greatly improved.''

Correct answer: B

Rationale: The correct answer is B: ''If you're concerned, let's talk about it.'' Offering to talk with the client encourages her to verbalize concerns, serving as an outlet for tension. The nurse's first step should be to listen to the client's concerns and emotions before providing more specific information. Choice A is incorrect as telling the client she should be concerned reinforces fears and conveys sympathy rather than empathy. Choice C is incorrect because telling the client not to worry and just concentrate on labor denies the client's feelings and cuts off communication. Choice D is incorrect as telling the client not to worry because care has improved denies the client's feelings and provides false reassurance.

3. Which of the following mental health situations is considered a psychiatric emergency?

• A. Seasonal Affective Disorder (SAD)
• B. Depression with melancholic features
• C. Major depressive episode with psychotic features
• D. Bipolar depression

Correct answer: C

Rationale: A major depressive episode with psychotic features is considered a psychiatric emergency because it poses a significant risk to the individual's safety. Psychotic features in depression can include hallucinations, delusions, or other severe symptoms that require immediate intervention. While Seasonal Affective Disorder (SAD) and depression with melancholic features are serious conditions, they do not inherently represent an acute emergency that necessitates immediate hospitalization. Bipolar depression, although severe, does not inherently involve psychotic symptoms that would classify it as a psychiatric emergency requiring immediate intervention. It's crucial to recognize the urgency and severity of major depressive episodes with psychotic features to ensure appropriate and timely treatment.

4. What is the nurse's priority action when a client receiving a unit of packed red blood cells experiences tingling in the fingers and headache?

• A. Call the health care provider (HCP).
• B. Stop the transfusion.
• C. Slow the infusion rate.
• D. Assess the intravenous (IV) site for infiltration.

Correct answer: B

Rationale: When a client receiving a packed red blood cell transfusion experiences tingling in the fingers and headache, these symptoms may indicate an adverse reaction to the transfusion. The nurse's priority action is to immediately stop the transfusion and initiate a normal saline infusion at a keep vein open (KVO) rate. This helps maintain the client's vein patency while addressing the adverse reactions. After stopping the transfusion and initiating the saline infusion, the nurse should assess the client, including vital signs evaluation. Subsequently, the healthcare provider should be notified. Calling the healthcare provider is important, but it should be done after the immediate action of stopping the transfusion. Slowing the infusion rate is not appropriate during a suspected transfusion reaction as it can exacerbate the adverse effects. Assessing the IV site for infiltration is a routine nursing intervention and is not the priority when managing a potential adverse reaction to a blood transfusion.

5. Which action by a client who requires an above-the-knee amputation for peripheral arterial disease best indicates emotional readiness for the surgery?

• A. Explains the goals of the procedure
• B. Displays few signs of anticipatory grief
• C. Participates in learning perioperative care
• D. Verbalizes acceptance of permanent dependency needs

Correct answer: C

Rationale: Participating actively in learning self-care demonstrates emotional acceptance of the need for surgery and readiness for planning post-surgery. Explaining the goals of the procedure may reflect intellectual readiness but not necessarily emotional readiness. A client who shows few signs of anticipatory grief may be suppressing emotions or in denial, which can hinder the emotional readiness. Verbalizing acceptance of permanent dependency needs suggests the client may require further education and emotional support, as it may not reflect a healthy emotional readiness for the surgery.

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