Nursing Elites

1. The nurse is assessing a 3-year-old child for symptoms of autism spectrum disorder (ASD). Which assessment finding should lead the nurse to question the diagnosis?

• A. Inability to react appropriately to social cues
• B. Engages in repetitive behaviors
• C. Comprehends language well beyond the complexity expected for age
• D. Displays self-destructive behavior

Correct answer: C

Rationale: The correct answer is 'Comprehends language well beyond the complexity expected for age.' Children with autism spectrum disorder typically struggle with language and communication skills, so comprehending language well beyond their age level would not align with the diagnosis of ASD. This finding could indicate other developmental strengths or delays. Choices A, B, and D are more commonly associated with ASD - the inability to react appropriately to social cues, engaging in repetitive behaviors, and displaying self-destructive behavior are typical manifestations of autism spectrum disorder.

2. Your patient has been diagnosed with herpes simplex virus 2. Which of the following would NOT be included in your teaching of this patient?

• A. If you have symptoms, you should avoid sexual contact with other individuals.
• B. With treatment, this condition can be cured.
• C. This disease is highly contagious.
• D. You may experience tingling in the skin before an active outbreak occurs.

Correct answer: B

Rationale: The correct answer is 'With treatment, this condition can be cured.' The treatment for herpes simplex virus (HSV) is symptomatic and palliative, aimed at managing symptoms rather than curing the infection. HSV is highly contagious, so sexual contact should be avoided during active outbreaks to prevent transmission. Many patients experience a tingling sensation in the skin before an active outbreak, known as a prodrome. Educating the patient that the condition is not curable but manageable with treatment is vital to set realistic expectations and promote proper management of the disease.

3. A nurse caring for a pediatric client shows little concern when the parents attempt to speak with her about their daughter's illness. When approached by the nurse manager about her behavior, the nurse responds by saying, 'I don't want to get involved. It doesn't matter what I do anyway; my work does not make much of a difference.' This nurse is exhibiting which of the following characteristics?

• A. Objectivity
• B. Depersonalization
• C. Procrastination
• D. Disruption

Correct answer: B

Rationale: The correct answer is 'Depersonalization.' A nurse who distances themselves from clients to avoid emotional involvement is displaying depersonalization. This behavior is often seen in nurses experiencing burnout due to stress. Depersonalization can stem from low morale, moral distress, and may serve as a defense mechanism to cope with stress and emotional exhaustion. It is a way to shield oneself from feeling overwhelmed by the burdens of caring for others. Choice A, 'Objectivity,' is incorrect because objectivity involves maintaining a neutral and unbiased perspective, which is not the case here. Choice C, 'Procrastination,' is incorrect as it refers to delaying tasks, not emotional distancing. Choice D, 'Disruption,' is irrelevant to the scenario described and does not align with the nurse's behavior of detachment and lack of concern.

4. The client with multiple sclerosis is being educated by the nurse on exercises and physical activities. Which statement by the client indicates a need for further teaching?

• A. "I can lift weights and engage in resistance training."?
• B. "I should exercise until I am exhausted."?
• C. "I can incorporate aerobic exercises into my routine."?
• D. "I should perform proper stretching before starting my routine."?

Correct answer: B

Rationale: The correct answer is, "I should exercise until I am exhausted."? This statement indicates a need for further teaching because patients with multiple sclerosis should avoid exercising to the point of exhaustion or fatigue. Strenuous physical activity can increase body temperature and potentially worsen symptoms in individuals with multiple sclerosis. Choice A is correct because lifting weights and resistance training can be appropriate exercises for patients with multiple sclerosis. Choice C is valid because aerobic exercises can also be beneficial. Choice D is accurate as proper stretching before starting an exercise routine is essential for preventing injuries.

5. Jack is a 2-month-old with a diagnosis of spinal muscular atrophy (SMA) type I. He has been admitted to the hospital for progressive respiratory difficulty. His parents have been informed that if he is not placed on ventilatory support, he will continue to decompensate and die of respiratory failure. Jack's physician discusses the poor prognosis of Jack's condition, and tells the parents that he will not be able to be removed from ventilatory support once it is initiated, due to his progressive neurological disease. After much discussion, the parents have decided to decline ventilatory support, agree to a do not resuscitate (DNR) order, and request hospice care for Jack. Another parent heard them discussing Jack's situation in the waiting room and says she could never do that to her baby. What is the most appropriate response to this parent?

• A. You never know what you'll do until you're in that situation.
• B. I can't discuss another patient's situation.
• C. They have been through too much already.
• D. You can contact administration with your concerns.

Correct answer: B

Rationale: In healthcare settings, privacy regulations prevent professionals from discussing patient situations with individuals not involved in that patient's care. Maintaining patient confidentiality is crucial to protect sensitive information. In this scenario, sharing details about Jack's situation with the parent who overheard the conversation would breach confidentiality. It is important to handle such situations delicately, especially in emotional environments like intensive care unit waiting rooms. While empathy and support are essential, it is equally crucial to respect patient privacy and confidentiality. Therefore, responding with 'I can't discuss another patient's situation' is the most appropriate and professional response in this context.

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