Nursing Elites

1. Which feeling would be difficult for a client with major depression to express?

• A. Need for comforting
• B. Anger toward others
• C. Remorse for past behaviors
• D. Feelings of low self-esteem

Correct answer: B

Rationale: Clients with major depression often have difficulty expressing anger toward others as their anger is typically directed inwards. Expressing the need for comforting is common among clients with major depression. They can also articulate remorse for past behaviors to an excessive degree. Furthermore, feelings of low self-esteem can be openly expressed by clients with major depression. Therefore, the difficulty in expressing anger toward others is the most appropriate choice as clients with major depression tend to internalize their anger.

2. Which nursing action promotes psychosocial development for a newborn?

• A. Washing hands before holding the newborn
• B. Measuring the newborn using an approved length board
• C. Weighing the newborn on the same scale during hospitalization
• D. Placing the newborn in the mother's arms during the first hour of life

Correct answer: D

Rationale: Placing the newborn in the mother's arms during the first hour of life is a crucial nursing action that promotes psychosocial development by fostering bonding between the newborn and the mother. This skin-to-skin contact enhances emotional attachment, facilitates breastfeeding initiation, and provides a sense of security for the newborn. It helps in regulating the newborn's temperature, heart rate, and breathing, promoting overall well-being. Washing hands before holding the newborn is essential for infection prevention and control to maintain the newborn's health and safety. Measuring the newborn using an approved length board and weighing the newborn on the same scale during hospitalization are assessments aimed at monitoring the newborn's physical growth and development, rather than directly promoting psychosocial well-being.

3. When emptying 350 mL of pale yellow urine from a client's urinal, the nurse notes that this is the first time the client has voided in 4 hours. Which action should the nurse take next?

• A. Record the amount on the client's fluid output record.
• B. Encourage the client to increase oral fluid intake.
• C. Notify the healthcare provider of the findings.
• D. Palpate the client's bladder for distention.

Correct answer: A

Rationale: The correct action for the nurse to take next is to record the amount of urine output on the client's fluid output record. The urine color and volume are within normal limits, indicating adequate hydration. There is no indication of a need to encourage increased oral fluid intake or notify the healthcare provider as the findings are normal. Palpating the client's bladder for distention is unnecessary in this scenario since the client has successfully voided a normal amount of urine after 4 hours.

4. Which of the following is a symptom associated with sensory overload?

• A. Disorientation
• B. Drowsiness
• C. Emotional lability
• D. Depression

Correct answer: A

Rationale: Disorientation is a common symptom associated with sensory overload. When an individual experiences sensory overload, their brain may become overwhelmed with excessive information, leading to disorientation. This can manifest as an inability to concentrate, racing thoughts, and restless behavior. Sensory overload occurs when a person is unable to either control the amount of environmental stimuli they are exposed to or process the stimuli effectively. Drowsiness, emotional lability, and depression are not typical symptoms of sensory overload. Drowsiness may indicate fatigue or boredom, emotional lability refers to rapid and exaggerated changes in mood, and depression is a mood disorder characterized by persistent feelings of sadness and hopelessness.

5. The health care provider has changed a client's prescription from the PO to the IV route of administration. The nurse should anticipate which change in the pharmacokinetic properties of the medication?

• A. The client will experience increased tolerance to the drug's effects and may need a higher dose.
• B. The onset of action of the drug will occur more rapidly, resulting in a more rapid effect.
• C. The medication will be more highly protein-bound, increasing the duration of action.
• D. The therapeutic index will be increased, placing the client at greater risk for toxicity.

Correct answer: B

Rationale: When changing the route of administration from PO to IV, the absorption process is bypassed, leading to a more rapid onset of action of the medication and consequently a quicker effect. Choices A, C, and D are incorrect. Increased drug tolerance and higher doses are not typical outcomes of changing the route of administration. Protein binding does not increase with a change to IV administration; rather, it is the bioavailability and onset of action that are affected. Moreover, an increased therapeutic index reduces the risk of drug toxicity, contrary to what is stated in choice D.

Similar Questions