Nursing Elites

1. In a group therapy setting, one member is very demanding, repeatedly interrupting others and taking most of the group time. The nurse's best response would be:

• A. Will you briefly summarize your point because others need time as well?
• B. Your behavior is obnoxious and drains the group.
• C. I am so frustrated with your behavior.
• D. To ignore the behavior and allow him to vent

Correct answer: A

Rationale: In a group therapy setting, where each member should have the opportunity to participate, it is essential for the nurse to manage disruptive behavior assertively yet respectfully. Choice A is the best response as it addresses the issue of one member dominating the group time by asking them to summarize their point briefly, allowing others to contribute. Choice B is confrontational and may alienate the individual, hindering the therapeutic process. Choice C expresses personal frustration, which is not constructive in managing the situation. Choice D of ignoring the behavior is not effective as it allows the disruptive behavior to continue, impacting the group dynamics negatively.

2. What is a priority when providing care for a patient with a newly inserted tracheostomy?

• A. Keeping the tracheostomy tube clean and dry
• B. Providing regular oral hygiene
• C. Monitoring for signs of infection and ensuring a patent airway
• D. Encouraging the patient to cough and deep breathe

Correct answer: C

Rationale: When caring for a patient with a newly inserted tracheostomy, the priority is to monitor for signs of infection and ensure a patent airway. This is crucial to prevent complications such as airway obstruction or infection. While keeping the tracheostomy tube clean and dry is important for overall care, it is not the highest priority when compared to ensuring a patent airway. Providing regular oral hygiene is essential for the patient's comfort but takes a secondary role to maintaining airway patency. Encouraging the patient to cough and deep breathe may be beneficial but is not as critical as monitoring for infection and keeping the airway clear.

3. What should the nurse do to complete a focused assessment for a female client with inflamed and painful hemorrhoids?

• A. Determine if the client uses any over-the-counter preparations for hemorrhoids
• B. Place the client in a standing position, leaning over the exam bed for inspection
• C. Position the client in the left lateral position to inspect the perineal area for fissures or sacs
• D. Ask the client how long she has experienced discomfort related to hemorrhoids

Correct answer: D

Rationale: Asking the client about the duration of discomfort related to hemorrhoids is the best intervention to implement for a focused assessment. This information provides important context for assessing the severity and chronicity of the condition, which is crucial for developing an appropriate care plan. Choices A, B, and C do not directly address the need to gather information about the duration of symptoms, which is essential for understanding the client's condition.

4. When a woman in early pregnancy is leaving the clinic, she blushes and asks the nurse if it is true that sex during pregnancy is bad for the baby. What is the best response for the nurse to give?

• A. The baby is protected by the sac. Sex is perfectly alright.
• B. It is unlikely to harm the baby. What you do with your personal life is your concern.
• C. Intercourse during pregnancy is usually alright, but you need to ask the doctor if it is acceptable for you.
• D. In a normal pregnancy, intercourse will not harm the baby. However, many women experience a change in desire. How are you feeling?

Correct answer: D

Rationale: Choice D is the best response as it reassures the patient that intercourse in a normal pregnancy will not harm the baby. It also shows empathy by acknowledging that many women experience changes in sexual desire during pregnancy. This response validates the patient's concerns and opens up a dialogue about her feelings. Choice A is incorrect as it lacks information about changes in sexual desire and oversimplifies the situation. Choice B is dismissive of the patient's concerns and does not provide adequate information. Choice C is not the best response as it suggests asking the doctor without offering immediate reassurance or addressing the patient's worries.

5. Which task could the nurse safely delegate to the UAP?

• A. Oral feeding of a two-year-old child after application of a hip spica cast
• B. Assessment of the placement and patency of an NG tube
• C. Participation in staff rounds to record notes regarding client goals
• D. Evaluation of a client's incisional pain following narcotic administration

Correct answer: A

Rationale: The correct answer is A because oral feeding of a stable child is a task that can be safely delegated to a UAP. This task does not require nursing assessment or clinical judgment. Choice B involves assessment, which requires the nurse's clinical judgment. Choice C involves recording client goals during staff rounds, which may require interpretation and understanding of the goals set. Choice D involves evaluating a client's pain following medication administration, which requires assessment and clinical judgment by a nurse.

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