Nursing Elites

1. The client is a 35-year-old multiparous individual scheduled for a tubal ligation. The nurse assesses the client's emotional response to the planned procedure. Which factor in the client's history will contribute to the healthy resolution of any emotional problem associated with sterilization?

• A. Belief that the surgery will relieve her monthly dysmenorrhea
• B. Knowledge that her partner does not want to have any more children
• C. Feeling that her family is complete and she now has the children she planned for
• D. Recovery from her previous complicated birth and a desire to avoid another birth

Correct answer: C

Rationale: The correct answer is feeling that her family is complete and she now has the children she planned for. Many couples in their 30s who feel that their families are complete choose sterilization as their method of contraception. Sterilization by means of tubal ligation should not be expected to have an effect on dysmenorrhea. The decision to undergo sterilization should be the individual's own choice and should not be influenced by others, including partners. Decisions regarding sterilization should ideally be made when the individual is not under stress, such as after recovery from a previous complicated birth. Therefore, the key factor contributing to a healthy resolution of emotional issues related to sterilization is the feeling of family completeness and achieving the planned number of children.

2. When a client who has had a mastectomy sees her incision for the first time, she exclaims, 'I look horrible! Will it ever look better?' Which response would the nurse provide?

• A. 'You seem shocked by the way you look now.'
• B. 'Now that the tumor is gone, the area will heal quickly.'
• C. After it heals, others won't even know you had surgery.'
• D. 'You will feel better about it when the swelling subsides.'

Correct answer: A

Rationale: The correct response, 'You seem shocked by the way you look now,' acknowledges the client's feelings and provides an opportunity for the client to express emotions freely. This reflection of feelings may help promote eventual acceptance of body image changes. Choices B, C, and D provide false reassurance and negate the client's feelings. Saying that the area will heal quickly now that the tumor is gone dismisses the client's concerns. Similarly, stating that others won't know about the surgery or that the client will feel better once the swelling subsides does not address the client's current emotional state and may undermine trust in the nurse-client relationship.

3. Before discharging an anxious client, which information about anxiety would the nurse teach the family?

• A. Anxiety is a totally unique feeling and experience.
• B. Apprehension is generalized to the total environment.
• C. Fears result from conscious actions, thoughts, and wishes.
• D. Anxiety is a pattern of emotional and behavioral responses to stress.

Correct answer: D

Rationale: Anxiety is a human response consisting of both physical and emotional changes that everyone experiences when faced with stressful situations. It is a pattern of emotional and behavioral responses to stress. Anxiety is a common experience for many individuals. Apprehension is usually related to a specific aspect of the environment rather than the total environment. Fears are not intentionally or consciously generated.

4. Under what patient conditions or situations are restraints sometimes used?

• A. As punishment when the patient is uncontrollable
• B. To prevent the patient from pulling their IV out
• C. When a patient is a danger to self and others
• D. Both B and C

Correct answer: D

Rationale: Restraints are sometimes used to prevent a patient from pulling out their IV or another life-saving tube and when the person poses a serious danger to themselves and/or others. Restraints are never used as a form of punishment. Choice A is incorrect because restraints are not utilized for punishment but for patient safety and care. Choice B and C are correct because they reflect the appropriate and necessary situations where restraints may be used in healthcare settings.

5. Which response would the nurse make to a client with schizophrenia who claims to be Joan of Arc about to be burned at the stake?

• A. ''Tell me more about being Joan of Arc.''
• B. 'We both know that you're not Joan of Arc.''
• C. ''It seems like the world is a pretty scary place for you.''
• D. 'You're safe here, because we won't let you be burned.''

Correct answer: C

Rationale: The nurse would say, ''It seems like the world is a pretty scary place for you.'' This response allows the nurse to understand the symbolism, reflect on and acknowledge the client's feelings, and help preserve the client's integrity. The statement, ''Tell me more about being Joan of Arc,'' validates the client's delusion and does not test reality. The statement, ''We both know that you're not Joan of Arc,'' rejects the client's feelings and does not address the client's fears of being harmed; clients cannot be argued out of delusions. The statement, ''You're safe here, because we won't let you be burned,'' is false reassurance; the nurse is agreeing with the client's false perceptions of reality, which is nontherapeutic.

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