Nursing Elites

1. The nurse is developing a care plan for a client with severe anxiety. An appropriate outcome for the client is that within 4 days the client should:

• A. Have decreased anxiety.
• B. Talk to the nurse for 10 minutes.
• C. Sit quietly for 30 minutes.
• D. Develop an adaptive coping mechanism.

Correct answer: B

Rationale: When developing outcome criteria for a client with severe anxiety, it is crucial for the goals to be specific, measurable, and realistic. In this scenario, the most appropriate outcome is for the client to talk to the nurse for 10 minutes within 4 days. This goal is specific (talking for a defined duration), measurable (10 minutes), and realistic given the client's condition. Expecting a severely anxious client to sit quietly for 30 minutes is not realistic and may even exacerbate their anxiety. While developing an adaptive coping mechanism is important, it is a broader long-term goal and may not be achievable within the specified timeframe. Having decreased anxiety is a desirable outcome, but it lacks specificity and measurability, making it less suitable as an immediate goal.

2. The nurse is making initial rounds on a client with a C5 fracture and crutch field tongs. Which equipment should be kept at the bedside?

• A. A pair of forceps
• B. A torque wrench
• C. A pair of wire cutters
• D. A screwdriver

Correct answer: B

Rationale: A torque wrench is essential equipment to keep at the bedside for a client with a C5 fracture and crutch field tongs. This tool is used to tighten and loosen the screws of the crutch field tongs, allowing the nurse to adjust the pressure on the screws for proper support and alignment. A pair of forceps (choice A), wire cutters (choice C), and a screwdriver (choice D) are not required for managing crutch field tongs and, therefore, are incorrect choices in this scenario.

3. The nurse is caring for a client with a malignancy. The classification of the primary tumor is Tis. The nurse should plan care for a tumor:

• A. That can be assessed
• B. That is in situ
• C. With increasing lymph node involvement
• D. With distant metastasis

Correct answer: B

Rationale: The correct answer is B: 'That is in situ.' Cancer in situ means that the cancer is still localized to the primary site. Cancer is graded in terms of tumor, grade, node involvement, and metastasis. Answer A is incorrect because Tis indicates a tumor that is in situ and can be assessed. Answer C is incorrect because T indicates tumor, not node involvement. Answer D is incorrect because a tumor that is in situ is not metastasized.

4. When assessing a client's self-expectations about weight loss, which question is most appropriate?

• A. "What makes you think you can change your eating habits?"?
• B. "How do you feel about losing weight?"?
• C. "How important is it that you lose weight?"?
• D. "What do you think is a realistic weekly weight loss for you?"?

Correct answer: D

Rationale: When assessing a client's self-expectations about weight loss, it is crucial to inquire about what the client considers a realistic weekly weight loss goal. This question helps in understanding the client's perception and expectations regarding the weight loss journey, enabling the establishment of achievable goals. Choices A, B, and C do not directly address the aspect of setting realistic goals for weight loss. While questioning about changing eating habits, feelings about losing weight, or the importance of weight loss are relevant, they do not specifically focus on setting achievable goals, which is essential for effective weight management.

5. Some drugs are excreted into bile and delivered to the intestines. Prior to elimination from the body, the drug might be absorbed. This process is known as:

• A. hepatic clearance.
• B. total clearance.
• C. enterohepatic cycling.
• D. first-pass effect.

Correct answer: C

Rationale: The correct answer is 'enterohepatic cycling.' This process involves drugs being excreted into bile, delivered to the intestines, reabsorbed into the circulation, and can prolong the drug's presence in the body. 'Hepatic clearance' (Choice A) refers to the amount of drug eliminated by the liver. 'Total clearance' (Choice B) is the sum of all types of clearance including renal, hepatic, and respiratory. 'First-pass effect' (Choice D) is the amount of drug absorbed from the GI tract and metabolized by the liver before entering circulation, reducing the amount of drug available for systemic circulation.

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