Nursing Elites

1. If a client is suffering from thyroid storm, the PN can expect to find on assessment:

• A. tachycardia and hyperthermia.
• B. bradycardia and hypothermia.
• C. a large goiter.
• D. a calm, quiet client

Correct answer: A

Rationale: In thyroid storm, there is an excess of thyroxine, leading to symptoms such as tachycardia (rapid heart rate) and hyperthermia (increased body temperature). Atrial fibrillation and palpitations are also commonly observed. Choices B and C are more indicative of hypothyroidism, where the thyroid is underactive, leading to bradycardia (slow heart rate), hypothermia (decreased body temperature), and the development of a large goiter. Choice D, a calm, quiet client, is unlikely in a thyroid storm where the individual would typically present with symptoms of agitation and restlessness due to the hypermetabolic state.

2. A client is having psychological counseling for problems communicating with his mother. Which model of stress is the most useful in reference to this stressor?

• A. Adaptation Model
• B. Stimulus-Based Model
• C. Transaction-Based Model
• D. Selye's Model of Stress

Correct answer: C

Rationale: The Transaction-Based Model, proposed by R.S. Lazarus, is the most relevant model of stress in the context of a client facing communication issues with his mother. This model takes into consideration individual differences and cognitive processes that occur between a stressor and the individual's response. It emphasizes the importance of how the individual perceives and interprets the stressor, incorporating mental and psychological components. In this scenario, the client's difficulties in communicating with his mother involve complex cognitive processes and individual perceptions, making the Transaction-Based Model the most suitable choice. The other options are not as relevant in this context: the Adaptation Model focuses on adjustment to stress over time, the Stimulus-Based Model emphasizes external factors as stressors, and Selye's Model of Stress mainly centers on the physiological response to stress.

3. Signs of impaired breathing in infants and children include all of the following except:

• A. nasal flaring
• B. grunting
• C. seesaw breathing
• D. quivering lips

Correct answer: D

Rationale: Signs of impaired breathing in infants and children typically include nasal flaring, grunting, and seesaw breathing. Nasal flaring is the widening of the nostrils during breathing to help with air intake, grunting is a sound made during expiration to keep the airway open, and seesaw breathing is an abnormal pattern where the chest moves in while the abdomen moves out. Quivering lips are not a typical sign of impaired breathing in infants and children, making it the correct answer. Nasal flaring, grunting, and seesaw breathing are all signs indicating the need for immediate medical attention due to potential respiratory distress.

4. The nurse is caring for a client following an appendectomy. The client reports nausea and complains of surgical site pain at a 6 on a 0 to 10 scale. The client's employer is present in the room and states he is paying for the insurance and wants to know what pain medication has been prescribed by the physician. Which of the following is the appropriate nurse response?

• A. Answer any questions the employer may have as he pays for the insurance.
• B. Tell the employer his question is inappropriate and that the information is none of his business.
• C. Explain to the employer that you cannot release private information and ask the employer to step out while you conduct your assessment of the client.
• D. Ask the employer to leave and wait until the client returns home to visit.

Correct answer: C

Rationale: The appropriate nurse response is to explain to the employer that private information cannot be released and ask the employer to step out while conducting the assessment. This approach respects the client's privacy while still acknowledging the employer. The employer's payment for insurance does not grant rights to confidential information. Sharing information without permission violates the client's right to privacy under HIPAA. Option A is incorrect as it compromises the client's confidentiality by sharing private medical information. Option B is inappropriate and unprofessional as it does not address the situation respectfully. Option D is incorrect as it does not prioritize the client's immediate needs and assumes the client's consent without proper communication.

5. With a breech presentation, the nurse must be particularly alert for which of the following?

• A. quickening
• B. ophthalmia neonatorum
• C. pica
• D. prolapsed umbilical cord

Correct answer: D

Rationale: With a breech presentation, the nurse must be particularly alert for a prolapsed umbilical cord. Prolapsed umbilical cord is a critical emergency situation where the umbilical cord descends into the vagina before the fetal presenting part, leading to compression between the presenting part and the maternal pelvis. This compression can compromise or completely cut off fetoplacental perfusion, endangering the fetus. Immediate delivery should be attempted to save the fetus. Quickening refers to fetal movements felt by the mother, ophthalmia neonatorum is an eye infection in newborns, and pica is a condition characterized by cravings for non-nutritive substances, none of which are directly related to the risks associated with a breech presentation and prolapsed umbilical cord.

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