Nursing Elites

1. If the nurse who was not promoted tells another friend, "I knew I'd never get the job. The hospital administrator hates me."? If she actually believes this of the administrator, who, in reality, knows little of her, she is demonstrating:

• A. compensation.
• B. reaction formation.
• C. projection.
• D. denial.

Correct answer: C

Rationale: The nurse is demonstrating projection, attributing her own feelings of dislike onto the hospital administrator. This defense mechanism involves unconsciously adopting blaming behavior. Compensation involves emphasizing a strong point to make up for a perceived weakness, which is not the case here. Reaction formation is adopting behavior opposite to actual feelings, and denial involves ignoring an unpleasant reality, none of which are demonstrated in this scenario.

2. The client is taking prednisone 7.5mg po each morning to treat his systemic lupus erythematosus. Which statement best explains the reason for taking the prednisone in the morning?

• A. There is less chance of forgetting the medication if taken in the morning.
• B. There will be less fluid retention if taken in the morning.
• C. Prednisone is absorbed best with the breakfast meal.
• D. Morning administration mimics the body's natural secretion of corticosteroid.

Correct answer: D

Rationale: Taking corticosteroids in the morning mimics the body's natural release of cortisol, which follows a diurnal pattern with higher levels in the morning. This timing helps regulate the body's inflammatory response and minimizes potential side effects. Answer A is not the primary reason for morning dosing, as adherence concerns can be addressed through other means. Answer B is incorrect since fluid retention is not influenced by the timing of prednisone administration. Answer C is also incorrect as prednisone absorption is not significantly affected by whether it is taken with breakfast or not.

3. The nurse is assigning staff for the day. Which assignment should be given to the nursing assistant?

• A. Taking the vital signs of the 5-month-old with bronchiolitis
• B. Taking the vital signs of the 10-year-old with a 2-day postappendectomy
• C. Administering medication to the 2-year-old with periorbital cellulitis
• D. Adjusting the traction of the 1-year-old with a fractured tibia

Correct answer: B

Rationale: The most appropriate assignment for a nursing assistant is to take the vital signs of a stable patient. A 10-year-old with a 2-day postappendectomy is considered stable, and routine vital signs monitoring can be safely delegated to a nursing assistant. Clients with bronchiolitis, periorbital cellulitis, and a fractured tibia require more specialized care and assessment by a licensed nurse. Bronchiolitis involves an airway alteration, periorbital cellulitis indicates an infection, and a fractured tibia may raise concerns of abuse. Therefore, options A, C, and D are incorrect for delegation to a nursing assistant.

4. A teenage client is admitted to the hospital because of an acetaminophen (Tylenol) overdose. Overdoses of acetaminophen can precipitate life-threatening abnormalities in which of the following organs?

• A. lungs
• B. liver
• C. kidneys
• D. adrenal glands

Correct answer: B

Rationale: Acetaminophen is extensively metabolized in the liver. An acetaminophen overdose can lead to severe liver damage and even liver failure, which can be life-threatening. Choices A, C, and D are incorrect. Acetaminophen overdose does not typically cause life-threatening problems in the lungs, kidneys, or adrenal glands. While prolonged acetaminophen use may increase the risk of renal dysfunction, a single overdose primarily affects the liver.

5. The primary organ for drug elimination is the:

• A. skin
• B. lung(s)
• C. kidney(s)
• D. liver

Correct answer: C

Rationale: The correct answer is the kidney(s) because most drugs are excreted in the urine, either as the parent compound or as drug metabolites. The skin is not the primary organ for drug elimination; only a few drugs are excreted in sweat. The lung(s) primarily excrete volatile gases with expiration, not drugs. While the liver metabolizes drugs, it is the kidney(s) that primarily eliminate drugs through urine, especially those with a molecular weight above 300.

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