Nursing Elites

1. In performing a psychosocial assessment, the nurse begins by asking questions that encourage the client to describe problematic behaviors and situations. The next step is to elicit the client's:

• A. feelings about what has been described
• B. thoughts about what has been described
• C. possible solutions to the problem
• D. intent in sharing the description

Correct answer: B

Rationale: In a psychosocial assessment, the nurse should progress from having the client describe problematic behaviors to eliciting their thoughts about the dilemmas. This step provides essential assessment data and insights into the client's interpretation of the situation. Asking about feelings, solutions, or intent in sharing the description is premature at this stage. Understanding the client's thoughts is crucial before delving into more complex emotional or problem-solving aspects. Therefore, the correct answer is to elicit the client's thoughts about the described behaviors and situations, as this helps the nurse gain a deeper understanding of the client's perspective and thought processes.

2. If the client is receiving peritoneal dialysis and the dialysate returns cloudy, what should the nurse do?

• A. Document the finding
• B. Send a specimen to the lab
• C. Strain the dialysate
• D. Obtain a complete blood count

Correct answer: B

Rationale: When the dialysate returns cloudy, it could indicate the presence of infection, and sending a specimen to the lab for evaluation is crucial to determine the cause. Documenting the finding alone, as in choice A, may not provide enough information for proper intervention. Straining the dialysate, as in choice C, is not a standard practice and may not help identify the underlying issue. Obtaining a complete blood count, as in choice D, is not directly related to addressing cloudiness in the dialysate. However, the healthcare provider might order a white blood cell count to assess for infection.

3. The ethical principle of keeping professional promises or obligations is:

• A. veracity
• B. autonomy
• C. fidelity
• D. beneficence

Correct answer: C

Rationale: The correct answer is fidelity. Fidelity is the ethical principle that refers to keeping professional promises or obligations. Veracity, however, relates to truth-telling. Autonomy is about client self-determination and decision-making. Beneficence, on the other hand, involves doing good and is crucial in the provision of nursing care.

4. In the United States, several definitions of death are currently being used. The definition that uses apnea testing and pupillary responses to light is termed:

• A. whole brain death.
• B. heart-lung death.
• C. circulatory death.
• D. higher brain death.

Correct answer: A

Rationale: The correct answer is 'whole brain death.' Most protocols for determining whole brain death require two separate clinical examinations, including the induction of painful stimuli, pupillary responses to light, oculovestibular testing, and apnea testing. This comprehensive approach ensures that all functions of the brain, including the brainstem, are evaluated to confirm the absence of brain function. Choices B and D are incorrect as they do not reflect the specific tests required for determining whole brain death. Choice C, 'circulatory death,' does not involve the evaluation of brain function and is not a current definition of death in the United States.

5. The client is visiting a home health client with osteoporosis. The client has a new prescription for alendronate (Fosamax). Which instruction should be given to the client?

• A. Rest in bed after taking the medication for at least 30 minutes
• B. Avoid rapid movements after taking the medication
• C. Take the medication with water only
• D. Allow at least 1 hour between taking the medicine and taking other medications

Correct answer: B

Rationale: When a client is prescribed alendronate (Fosamax), instructing them to avoid rapid movements after taking the medication is crucial to prevent esophageal irritation. Resting in bed after taking the medication for at least 30 minutes (choice A) is not necessary and can increase the risk of side effects. While taking the medication with water only (choice C) is generally recommended, the key instruction to prevent esophageal irritation is to avoid rapid movements. Allowing at least 1 hour between taking the medicine and other medications (choice D) is not specifically related to the administration of alendronate and is not the primary concern when giving instructions to the client.

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