Nursing Elites

1. Which initial response would the nurse make to a 67-year-old man with type 2 diabetes who sadly confides in the nurse that he has been unable to have an erection for several years?

• A. 'At your age, sex isn't that important.''
• B. ''That is a natural occurrence at your age.''
• C. ''You sound upset about not being able to have an erection.''
• D. 'Maybe it's time for you to speak to your primary health care provider about this.''

Correct answer: C

Rationale: The correct response is, 'You sound upset about not being able to have an erection.' When a client discloses personal information, the nurse should respond in a non-judgmental manner to encourage further communication and gather more details. This response demonstrates empathy and understanding, opening the door for the patient to express his feelings and concerns. Choice A, 'At your age, sex isn't that important,' is dismissive and fails to address the client's emotions or concerns, potentially hindering open communication. Choice B, 'That is a natural occurrence at your age,' provides inaccurate information as the inability to have an erection is not considered a normal part of aging. Choice D, 'Maybe it's time for you to speak to your primary health care provider about this,' while important eventually, should not be the initial response as the nurse should first explore the client's feelings and concerns before discussing potential referrals or interventions.

2. When bathing an uncircumcised boy older than 3 years, which action should the nurse take?

• A. Remind the child to clean his genital area.
• B. Defer perineal care because of the child's age.
• C. Retract the foreskin gently to cleanse the penis
• D. Ask the parents why the child is not circumcised

Correct answer: C

Rationale: When bathing an uncircumcised boy older than 3 years, it is essential to gently retract the foreskin to cleanse the penis. This helps in preventing the buildup of bacteria and maintaining good hygiene. Reminding the child to clean his genital area (Option A) may not be effective due to the child's cognitive development level. Perineal care should not be deferred (Option B) as it is necessary for maintaining hygiene at any age. Asking the parents why the child is not circumcised (Option D) is not relevant to the immediate care required during bathing.

3. Nursing behaviors associated with the implementation phase of the nursing process are concerned with:

• A. participating in the mutual identification of patient outcomes.
• B. gathering accurate and sufficient patient-centered data.
• C. comparing patient responses and expected outcomes.
• D. carrying out interventions and coordinating care.

Correct answer: D

Rationale: During the implementation phase of the nursing process, nurses focus on executing interventions and coordinating care. This involves utilizing available resources, performing necessary interventions, exploring alternatives when needed, and collaborating with other healthcare team members to ensure comprehensive care delivery. Choice A is incorrect as it pertains more to the planning phase where patient outcomes are identified. Choice B is incorrect as it relates to data collection, which is primarily a part of the assessment phase. Choice C is incorrect as it involves evaluating patient responses against expected outcomes, which is part of the evaluation phase.

4. A client has been diagnosed with a form of terminal cancer and has started receiving hospice care. The nurse notes that both the client and his family avoid talking about the diagnosis. All attempts at discussion result in changing the subject. The nurse recognizes that this family is exhibiting:

• A. Closed awareness
• B. Mutual pretense
• C. Open awareness
• D. Powerless assessment

Correct answer: B

Rationale: The correct answer is 'Mutual pretense.' Mutual pretense is a form of awareness as a response to death or dying in which those involved avoid discussing the situation. In this scenario, both the client and the family are aware of the terminal cancer diagnosis, but they choose not to talk about it openly. This behavior can stem from various reasons, such as trying to shield loved ones from grief, fear of the future, or discomfort with discussing emotions. 'Closed awareness' (Choice A) refers to a lack of awareness of the impending death, which is not the case here. 'Open awareness' (Choice C) involves open acknowledgment and discussion of the terminal illness, which is contrary to the behavior described. 'Powerless assessment' (Choice D) does not relate to the situation of avoiding discussing the diagnosis in the context of terminal cancer and hospice care.

5. The nurse plans care for a hospitalized patient who uses culturally based treatments. Which action by the nurse is best?

• A. Encourage the use of diagnostic procedures.
• B. Coordinate the use of folk treatments with ordered medical therapies.
• C. Ask the patient to discontinue the cultural treatments during hospitalization.
• D. Teach the patient that folk remedies will interfere with orders by the healthcare provider.

Correct answer: B

Rationale: The best action for the nurse is to coordinate the use of folk treatments with ordered medical therapies. Many culturally based therapies can complement Western treatments and medications. It is essential for the nurse to integrate both traditional folk treatments and Western therapies to provide holistic care. Some culturally based treatments can effectively complement Western medicine in treating diseases. Encouraging the patient to continue some culturally based treatments during hospitalization can enhance their overall well-being. Asking the patient to discontinue cultural treatments or teaching that folk remedies interfere with Western therapies may not align with the patient's beliefs and could hinder their care.

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