Nursing Elites

1. Gio told his nurse that the FBI is monitoring and recording his every movement and that microphones have been placed in the unit walls. Which action would be the most therapeutic response?

• A. Confront the delusional material directly by telling Gio that this simply is not so.
• B. Tell Gio that this must seem frightening to him but that you believe he is safe here.
• C. Tell Gio to wait and talk about these beliefs in his one-on-one counseling sessions.
• D. Isolate Gio when he begins to talk about these beliefs.

Correct answer: B

Rationale: The most therapeutic response in this situation is to acknowledge Gio's feelings of fear and validate his experience by expressing empathy ('this must seem frightening to him'). By reassuring Gio that he is safe in the current environment, the nurse can help reduce his anxiety and build trust. Choice A is not recommended as directly confronting delusional beliefs may lead to increased distress and resistance. Choice C delays addressing Gio's concerns and may not provide immediate support. Choice D of isolating Gio can worsen his feelings of paranoia and distrust in the treatment setting.

2. A nurse walks into a client's room to find the nursing assistant yelling, 'Sit back down or I won't help you eat, and then you will starve!' This type of behavior is known as:

• A. Psychological abuse
• B. Abandonment
• C. Material exploitation
• D. Physical abuse

Correct answer: A

Rationale: The correct answer is A: Psychological abuse. This behavior is classified as psychological abuse, which harms another person through words or threats. The nursing assistant's actions of yelling, making threats, and using food as a form of control fall under psychological abuse. Abandonment (choice B) refers to deserting or leaving a client without care, which is not the case in the scenario. Material exploitation (choice C) involves taking advantage of a person's assets or resources for personal gain, which is not evident here. Physical abuse (choice D) involves causing physical harm, which is not the primary issue in this situation. Therefore, the most appropriate classification for the behavior described in the scenario is psychological abuse.

3. A client has entered disseminated intravascular coagulation (DIC) after becoming extremely ill after surgery. Which of the following laboratory findings would the nurse expect to see with this client?

• A. Elevated fibrinogen level
• B. Prolonged PT
• C. Elevated platelet count
• D. Depressed d-dimer level

Correct answer: B

Rationale: In disseminated intravascular coagulation (DIC), a client experiences widespread clotting throughout the body, leading to the depletion of clotting factors and platelets. A prolonged prothrombin time (PT) is a common finding in DIC. The PT measures the extrinsic pathway of the clotting cascade and reflects how quickly blood can clot. In DIC, the consumption of clotting factors results in a prolonged PT, indicating impaired clotting ability. Elevated fibrinogen levels (Choice A) are typically seen in the early stages of DIC due to the body's attempt to compensate for clot breakdown. Elevated platelet count (Choice C) is not a typical finding in DIC as platelets are consumed during the widespread clotting. A depressed d-dimer level (Choice D) is also not expected in DIC as d-dimer levels are elevated due to the breakdown of fibrin clots. Therefore, the correct answer is a prolonged PT.

4. In which of the following examples would informed consent not be required?

• A. A patient is apprehensive about an upcoming surgery and chooses not to learn of the risks involved with the procedure.
• B. A child is rushed to the Emergency Room after falling from a third-story window.
• C. An adult in a coma in a mental health institution with no listed next of kin.
• D. Informed consent is not required in any of the above examples.

Correct answer: D

Rationale: In emergency situations where immediate treatment is necessary to prevent further harm or save a life, such as in option B where a child is rushed to the Emergency Room after a fall, informed consent may be waived to provide prompt care. In option A, though the patient is apprehensive about surgery and chooses not to learn the risks, informed consent is not required as it is the patient's right to refuse information. In option C, when an adult is in a coma with no next of kin listed, decisions may be made in the patient's best interest following legal and ethical guidelines. Therefore, informed consent is not needed in any of the scenarios presented.

5. An adolescent brings a physician's note to school stating that he is not to participate in sports due to a diagnosis of Osgood-Schlatter disease. Which of the following statements about the disease is correct?

• A. The condition is not caused by the student's competitive swimming schedule.
• B. The student will most likely not require surgical intervention.
• C. The student experiences pain in the inferior aspect of the knee.
• D. The student is not trying to avoid participation in physical education.

Correct answer: C

Rationale: Osgood-Schlatter disease occurs in adolescents during the rapid growth phase when the infrapatellar ligament of the quadriceps muscle pulls on the tibial tubercle, causing pain and swelling in the inferior aspect of the knee. The condition is commonly caused by activities that require repeated use of the quadriceps, such as track and soccer. Choice A is incorrect because Osgood-Schlatter disease is not specifically linked to competitive swimming. Choice B is incorrect as surgical intervention is not usually necessary for this condition. Choice D is incorrect as the student is not trying to avoid physical education but is restricted from participating in sports due to the diagnosis of Osgood-Schlatter disease.

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