Nursing Elites

1. What is the nurse's initial plan for providing pain relief measures during labor for a pregnant client with a history of opioid abuse?

• A. Scheduling pain medication at regular intervals
• B. Administering the medication only when the pain is severe
• C. Avoiding the administration of medication unless it is requested
• D. Recognizing that less pain medication will be needed by this client compared with other women in labor

Correct answer: A

Rationale: In a pregnant client with a history of opioid abuse, scheduling pain medication at regular intervals is the initial plan for providing pain relief during labor. This client may have a lower tolerance for pain and a greater need for pain relief. If medication is only administered when the pain is severe, larger doses may be needed, leading to increased anxiety and discomfort. Avoiding medication unless requested is not ideal, as proactive pain management is crucial during labor. Recognizing that less pain medication will be needed by this client compared with others is incorrect, as individuals with a history of opioid abuse often require more medication due to tolerance to addictive drugs.

2. The client finds a client crying behind a locked bathroom door. The client will not open the door. Which action should the nurse implement first?

• A. Instruct an unlicensed assistive personnel (UAP) to stay and keep talking to the client.
• B. Sit quietly in the client's room until the client leaves the bathroom.
• C. Allow the client to cry alone and leave the client in the bathroom.
• D. Talk to the client and attempt to find out why the client is crying.

Correct answer: D

Rationale: The nurse's first concern should be for the client's safety, so an immediate assessment of the client's situation is needed. Option D is the correct choice as it involves directly addressing the client's emotional state and attempting to understand the reason for the distress. In a vulnerable situation like this, the nurse should take the lead in assessing and communicating with the client. Option A is incorrect as it would delegate the responsibility to someone else when the nurse should be the one to initiate the assessment. Option B is inappropriate as it does not actively address the client's emotional needs or safety. Option C is also incorrect because leaving the client alone without further assessment could potentially endanger the client's well-being.

3. After informing an older client that an IV line needs to be inserted, the client becomes very apprehensive, loudly verbalizing a dislike for all healthcare providers and nurses. How should the nurse respond?

• A. Ask the client to remain quiet so the procedure can be performed safely.
• B. Concentrate on completing the insertion as efficiently as possible.
• C. Calmly reassure the client that the discomfort will be temporary.
• D. Tell the client a joke as a means of distraction from the procedure.

Correct answer: C

Rationale: The nurse should respond with a calm demeanor to help reduce the client's apprehension. By calmly reassuring the client that the discomfort from the procedure will be temporary, the nurse acknowledges the client's feelings and provides comfort. This response shows empathy and understanding, which can help build trust. Asking the client to remain quiet may escalate the situation and not address the client's underlying concerns. Concentrating solely on completing the insertion efficiently may overlook the client's emotional needs and may increase their anxiety. Telling a joke may not be appropriate in this serious situation and could be perceived as insensitive, failing to address the client's emotional distress effectively.

4. During the beginning phase of a therapeutic relationship, why is a clear understanding of participants' roles important?

• A. Understanding what will be discussed
• B. Knowing that the nurse is trying to be helpful
• C. Knowing what to expect from the relationship
• D. Preparing for termination of the relationship

Correct answer: C

Rationale: During the initial stages of a therapeutic relationship, having a clear understanding of participants' roles is crucial as it helps in defining the structure and boundaries of the relationship. This clarity assists in setting expectations and establishing a framework for interaction, allowing the client to focus on the therapeutic process rather than on uncertainties regarding their role or the nurse's role. Option A, understanding what will be discussed, is important but not directly related to defining roles. Option B, knowing that the nurse is trying to be helpful, is about the intent of the nurse rather than the roles of the participants. Option D, preparing for termination of the relationship, is premature in the beginning phase and not directly related to understanding roles.

5. The client admitted for uncontrolled diabetes is worried about how to pay bills for the family while hospitalized. Which statement by the nurse is therapeutic?

• A. "You are worried about paying your bills?"
• B. "Don't worry; your bills will get paid eventually."
• C. "When was the last time you were admitted for hyperglycemia?"
• D. "You really shouldn't be drinking alcohol because of your diagnosis of diabetes."

Correct answer: A

Rationale: The therapeutic communication technique used in this scenario is reflection. By repeating the client's concern, the nurse acknowledges the client's feelings and encourages further exploration of the topic. Choice A is correct as it reflects the client's worry without offering false assurance, advice, or using professional jargon. Choice B dismisses the client's concerns with false reassurance. Choice C introduces professional jargon, which may hinder effective communication. Choice D provides advice, which can limit the client's expression of feelings and concerns.

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