Nursing Elites

1. When a staff member is observed not following the plan of care for a client with an antisocial personality disorder, what should the nurse do?

• A. confront the staff member immediately and say, "You know that is not the treatment plan."?
• B. write an incident report to create a paper trail of the staff member's failure to follow the planned program.
• C. ask the staff member to talk in private, and reinforce how antisocial clients try to divide staff.
• D. bring up the incident during the weekly conference so that this staff member is not assigned to work with antisocial persons again.

Correct answer: C

Rationale: When a staff member is observed not following the plan of care for a client with an antisocial personality disorder, it is crucial to address the issue promptly and effectively. Confronting the staff member immediately in front of the client may worsen the situation by enhancing the division of staff and compromising client care. Writing an incident report, although important for documentation, may not address the immediate need to correct the behavior. Bringing up the incident during a weekly conference may not be the most effective approach for immediate resolution. Asking the staff member to talk in private and reinforcing how antisocial clients try to divide staff is the best option. This approach allows for a constructive conversation to address the issue, provide education, and help the staff member develop skills to work effectively with this client population.

2. Several clients are admitted to the emergency room following a three-car vehicle accident. Which clients can be assigned to share a room in the emergency department during the disaster?

• A. The schizophrenic client experiencing visual and auditory hallucinations and the client with ulcerative colitis
• B. The client who is 6 months pregnant with abdominal pain and the client with facial lacerations and a broken arm
• C. A child with fixed and dilated pupils and his parents, and the client with a frontal head injury
• D. The client who arrives with a large puncture wound to the abdomen and the client with chest pain

Correct answer: B

Rationale: The correct answer is to assign the client who is 6 months pregnant with abdominal pain and the client with facial lacerations and a broken arm to share a room. The pregnant client needs close monitoring due to the abdominal pain, and the client with facial lacerations and a broken arm requires immediate attention for wound care and possible fracture management. Choice A should not be assigned together as the schizophrenic client experiencing visual and auditory hallucinations needs a separate room for privacy and safety, and the client with ulcerative colitis may require isolation due to the risk of infection. Choice C is incorrect because the child with fixed and dilated pupils is likely in a critical condition and should be in a private room with parents, while the client with a frontal head injury needs a separate room for focused care. Choice D is also incorrect as the client with a large puncture wound to the abdomen needs immediate attention in a separate room, and the client with chest pain requires evaluation and monitoring in a separate setting as well.

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. Mrs. Owens is the 81-year-old mother of Jonathan, who is 54 years old. Jonathan has had schizophrenia since he was 16 years old. Which of Mrs. Owens's concerns is likely to predominate?

• A. "Will my retirement funds outlast me?"?
• B. "Who will handle my funeral arrangements?"?
• C. "What will become of Jonathan when I am gone?"?
• D. "How can I communicate effectively with Jonathan's physician?"?

Correct answer: C

Rationale: The most prominent concern for Mrs. Owens is likely what will happen to her son, Jonathan, after she passes away. While retirement fund sustainability is important, it is not likely to be her primary concern. Funeral arrangements, although significant, are secondary to the welfare of her son with schizophrenia. The question of how to communicate with Jonathan's physician is less likely to be a predominant concern since Mrs. Owens has likely already addressed this issue over the 38 years of managing her son's care.

5. The nurse is assigned to care for an infant with physiologic jaundice. Which action by the nurse would facilitate elimination of the bilirubin?

• A. Increasing the infant's fluid intake
• B. Maintaining the infant's body temperature at 98.6°F
• C. Minimizing tactile stimulation
• D. Decreasing caloric intake

Correct answer: A

Rationale: Bilirubin is excreted through the kidneys, therefore increasing fluid intake can help facilitate its elimination. Maintaining the infant's body temperature is important for overall health but does not directly assist in eliminating bilirubin, making choice B incorrect. Choices C and D are irrelevant to bilirubin elimination in this scenario and do not address the specific issue of physiologic jaundice.

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