Nursing Elites

1. Why might a nurse manager suggest avoiding therapeutic group work for a client with schizophrenia who has paranoid delusions?

• A. Individuals with this disorder respond well to small therapeutic groups.
• B. Therapeutic group work tends to be threatening to individuals who are suspicious.
• C. Compliance with unit rules and medication regimens increases as therapeutic group involvement increases.
• D. Involvement in small therapeutic groups may decrease the regression and dependency associated with institutionalization.

Correct answer: B

Rationale: The nurse manager would suggest avoiding therapeutic group work for a client with schizophrenia who has paranoid delusions because individuals who are suspicious find group settings threatening. Paranoid individuals struggle in groups as they may not trust others enough to engage effectively and tolerate the necessary interactions for group therapy. Therefore, the correct answer is that therapeutic group work tends to be threatening to individuals who are suspicious. Choices A, C, and D are incorrect. While some individuals with schizophrenia may respond well to small therapeutic groups, those with paranoid delusions may find them threatening. Compliance with unit rules and medication regimens may not necessarily increase with group therapy, especially for acutely ill psychiatric clients not ready to accept reality. Involvement in small therapeutic groups is not primarily aimed at decreasing regression and dependency associated with institutionalization, making it an inappropriate option for the client's specific needs.

2. After a needle stick occurs while removing the cap from a sterile needle, which action should the nurse take?

• A. Complete an incident report.
• B. Select another sterile needle.
• C. Disinfect the needle with an alcohol swab.
• D. Notify the supervisor of the department immediately.

Correct answer: B

Rationale: After a needle stick, the needle is considered contaminated and should be discarded. The nurse should select another sterile needle to use. Completing an incident report is not necessary in this situation because the needle was sterile when the nurse was stuck and not in contact with any other person's body fluids. Notifying the supervisor immediately is not required as the situation can be managed by selecting a new needle. Disinfecting the needle with an alcohol swab is not recommended as it does not meet the standards of safe practice and infection control.

3. Which signs and symptoms would the nurse observe in a client with schizophrenia?

• A. Traumatic flashbacks and hypervigilance
• B. Depression and psychomotor retardation
• C. Loosened associations and hallucinations
• D. Ritualistic behavior and obsessive thinking

Correct answer: C

Rationale: In clients with schizophrenia, the nurse would observe loosened associations and hallucinations. Loosened associations refer to disorganized thinking where thoughts are not logically connected. Hallucinations involve perceiving things that are not based in reality. Traumatic flashbacks and hypervigilance are more indicative of post-traumatic stress disorder. Depression and psychomotor retardation are common in depression, not schizophrenia. Ritualistic behavior and obsessive thinking are typically seen in obsessive-compulsive disorders, not schizophrenia.

4. Which approach would be most appropriate for the involved parent of a child diagnosed with Munchausen syndrome by proxy?

• A. Confrontation
• B. Open communication
• C. Health teaching about childrearing
• D. Validation of the child's physical status

Correct answer: B

Rationale: The most appropriate approach for the involved parent of a child diagnosed with Munchausen syndrome by proxy is open communication. Maintaining open communication is crucial in building a therapeutic nurse-client relationship. Confrontation may cause the parent to become defensive and hinder effective communication. Health teaching about childrearing may not be well-received at this point as the parent may not be ready for it. Validation of the child's physical status may inadvertently reinforce the parent's behavior by focusing solely on physical symptoms rather than addressing the underlying issues.

5. On her first visit to the neonatal intensive care unit to see her preterm newborn, the mother's only comment to the nurse is, 'My baby looks so fragile. Do you think my child will make it?' Which is the most appropriate response by the nurse?

• A. "Many infants born as small as yours have done just fine."
• B. "The staff is confident in your child's prognosis because preterm babies do look like this at first."
• C. "It's understandable that your baby looks fragile to you. What have you learned about the condition?"
• D. "Your baby is not as fragile as it appears. Do you find it so frightening that you can't touch your child?"

Correct answer: C

Rationale: The nurse's response should aim to convey acceptance and encourage the mother to express her concerns. By saying, "It's understandable that your baby looks fragile to you. What have you learned about the condition?", the nurse acknowledges the mother's feelings and prompts her to share her understanding, fostering further communication and addressing any misconceptions. Choices A and B dismiss the mother's concerns by making general statements and do not encourage dialogue. Choice D implies judgment and may deter the mother from opening up about her fears.

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