Nursing Elites

1. What approach should the nurse use when a manipulative client who uses acting-out behaviors asks the nurse to talk while the nurse is orienting a new client to the unit?

• A. Suggest that the client requesting attention speak with another staff member.
• B. Leave the new client, saying, 'I'll talk with the other client until things calm down.'
• C. Introduce the two clients and suggest that the client join them on a tour of the facility.
• D. Say to the interrupting client, 'I'll be back to talk with you after I orient this new client.'

Correct answer: D

Rationale: The nurse should respond to the manipulative client who uses acting-out behaviors by setting realistic limits on behavior without rejecting the client. Therefore, the correct approach is to say to the interrupting client, 'I'll be back to talk with you after I orient this new client.' This response acknowledges the client's request while prioritizing the needs of the new client and setting appropriate boundaries. Choices A, B, and C are incorrect. Suggesting that the client speak with another staff member would be a rejection of the client, not the behavior. Leaving the new client to attend to the manipulative client would encourage further manipulation and disrupt the orientation process for the new client. Introducing the two clients and suggesting a tour is inconsistent with setting limits and does not address the manipulative behavior being displayed.

2. A client admitted with a diagnosis of cervical cancer tells the nurse, 'I haven't had a Papanicolaou (Pap) smear for more than 8 years. I probably wouldn't be in the hospital today if I'd had those tests more often.' Which response would the nurse provide?

• A. ''Please tell me why you waited so long.''
• B. 'You feel as though you've neglected your health.''
• C. 'It's never too late to start taking care of yourself.''
• D. 'Most women hate to have Pap smears done, but they're really important.''

Correct answer: B

Rationale: The correct response, ''You feel as though you've neglected your health,'' is appropriate as it indicates recognition of expressed feelings, encouraging verbalization. This response is nondirective and reflective. Choice A, asking the client why she waited so long, ignores the client's current emotional needs and may cut off communication. Choice C, stating that it is never too late to start taking care of her health, is judgmental as it implies that the client has been negligent. Choice D, although acknowledging the importance of Pap smears, fails to address the client's current emotional state and needs.

3. The mother of an infant in the neonatal intensive care unit expresses concern about her infant. Which nursing intervention best facilitates mother-infant bonding?

• A. Asking the mother to change her baby's diaper
• B. Assuring the mother that her baby is receiving excellent care
• C. Encouraging the mother to touch her baby whenever possible
• D. Keeping the mother informed about the care the nursing staff is providing her baby

Correct answer: C

Rationale: Encouraging the mother to touch her baby whenever possible is the best intervention to promote mother-infant bonding, especially when the infant is too ill to be held. Physical touch is a powerful way to establish a connection. Mother-infant bonding is a gradual process and encouraging touch can help initiate this bond. Asking the mother to change her baby's diaper is not the most appropriate action to promote bonding in this scenario. Assuring the mother about the care her baby is receiving is important but does not directly enhance bonding. Keeping the mother informed about the care her baby is receiving is crucial, but it alone does not actively foster bonding between the mother and infant.

4. The nurse is performing an admission assessment for a non-English speaking patient who is from China. Which actions could the nurse take to enhance communication (select one that does not apply)?

• A. Use an electronic translation application.
• B. Use a telephone-based medical interpreter.
• C. Wait until an agency interpreter is available.
• D. Ask the patient's teenage daughter to interpret.

Correct answer: D

Rationale: Electronic translation applications, telephone-based medical interpreters, and agency interpreters are all appropriate tools to enhance communication with non-English-speaking patients. However, asking the patient's teenage daughter to interpret is not recommended due to potential misinterpretation of crucial information during the admission assessment. While family members may be considered in the absence of a professional interpreter, there is a risk of misunderstanding or lack of sharing essential details. It is important to rely on trained interpreters to ensure accurate communication and avoid miscommunication or misinterpretation of critical information. Using gestures can be helpful, but over-exaggeration of gestures is unnecessary and may lead to confusion.

5. A client who has multiple sclerosis is admitted to the hospital with increasingly frequent and severe exacerbations. One day, the client's partner confides to the nurse, 'Life is getting very hard and depressing, and I am upset with myself for thinking about a nursing home.' After listening to the partner's concerns, which response would the nurse make?

• A. 'Joining a support group of people who are coping with this situation may be helpful.'
• B. 'You may be able to decrease your feelings of guilt by seeking counseling.'
• C. 'It would be helpful if you became involved in volunteer work at this time.'
• D. 'I recognize it's hard to deal with, but try to remember that this, too, shall pass.'

Correct answer: A

Rationale: Joining a support group of individuals facing similar circumstances can provide valuable support and the opportunity to share experiences, making it the most appropriate response. The response suggesting counseling to decrease feelings of guilt is premature because the partner did not directly express guilt and it may not be the most immediate need. Suggesting involvement in volunteer work at this time fails to address the partner's current emotional distress and may come across as dismissive. Offering false reassurance by stating 'this, too, shall pass' does not validate the partner's feelings and minimizes the seriousness of their concerns.

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