Nursing Elites

1. Which response would the nurse make to a client with schizophrenia who claims to be Joan of Arc about to be burned at the stake?

• A. ''Tell me more about being Joan of Arc.''
• B. 'We both know that you're not Joan of Arc.''
• C. ''It seems like the world is a pretty scary place for you.''
• D. 'You're safe here, because we won't let you be burned.''

Correct answer: C

Rationale: The nurse would say, ''It seems like the world is a pretty scary place for you.'' This response allows the nurse to understand the symbolism, reflect on and acknowledge the client's feelings, and help preserve the client's integrity. The statement, ''Tell me more about being Joan of Arc,'' validates the client's delusion and does not test reality. The statement, ''We both know that you're not Joan of Arc,'' rejects the client's feelings and does not address the client's fears of being harmed; clients cannot be argued out of delusions. The statement, ''You're safe here, because we won't let you be burned,'' is false reassurance; the nurse is agreeing with the client's false perceptions of reality, which is nontherapeutic.

2. Your patient has been confused for years. Your patient can be best described as having a chronic ___________ disorder.

• A. physical
• B. psychotic
• C. thinking
• D. palliative

Correct answer: C

Rationale: Patients who experience long-term confusion often have a chronic thinking, or cognitive, disorder. Alzheimer's disease is a prime example of a disorder that results in prolonged confusion and memory loss. Choice A, 'physical', is incorrect as the issue described is related to cognitive functioning, not physical health. Choice B, 'psychotic', refers to a severe mental disorder characterized by a loss of contact with reality, which is not the primary issue presented in the scenario. Choice D, 'palliative', is not relevant as it pertains to specialized medical care for individuals with serious illnesses, focusing on providing relief from symptoms and stress rather than managing chronic confusion.

3. One week after being told that she has terminal cancer with a life expectancy of 3 weeks, a female client tells the nurse, 'I think I will plan a big party for all my friends.' How should the nurse respond?

• A. 'You may not have enough energy before long to hold a big party.'
• B. 'Do you mean to say that you want to plan your funeral and wake?'
• C. 'Planning a party and thinking about all your friends sounds like fun.'
• D. 'You should be thinking about spending your last days with your family.'

Correct answer: C

Rationale: Setting goals that bring pleasure is appropriate and should be encouraged by the nurse as long as the nurse does not perpetuate a client's denial. Option A is a negative response, implying that the client should not plan a party, which is not supportive. Option B is presumptive and may not reflect the client's true intentions. The correct response (Option C) acknowledges the client's positive plans and encourages her to enjoy her time with friends. Option D, while family is important, does not consider the client's wishes and choices, which should be respected and supported in this situation.

4. According to Erikson's theory, which behavior would the nurse expect a preschooler to exhibit?

• A. The child develops the superego.
• B. The child plays beside other children.
• C. The child concentrates on work and play.
• D. The child becomes casual about body appearance.

Correct answer: A

Rationale: According to Erikson's theory, a preschooler develops the superego or conscience during the initiative versus guilt stage. This stage occurs around ages 3 to 6 years old. The development of the superego is crucial for the child to start understanding and internalizing societal and parental values. Choice B is incorrect because playing beside other children typically occurs during the autonomy versus shame and doubt stage, which is seen in toddlers. Choice C is incorrect as concentrating on work and play is more characteristic of the industry versus inferiority stage, typically seen in school-aged children. Choice D is incorrect because becoming casual about body appearance is more aligned with the identity versus role confusion stage, which is seen in adolescents who have a marked preoccupation with appearance and body image.

5. What is a priority goal of involuntary hospitalization of the severely mentally ill client?

• A. Re-orientation to reality
• B. Elimination of symptoms
• C. Protection from harm to self or others
• D. Return to independent functioning

Correct answer: C

Rationale: The priority goal of involuntary hospitalization of severely mentally ill clients is to ensure protection from harm to self or others. Involuntary hospitalization is often necessary for individuals who are deemed dangerous to themselves or others or who are considered gravely disabled. Re-orientation to reality, elimination of symptoms, and return to independent functioning are important aspects of mental health care but are not the primary goals of involuntary hospitalization. The main focus during involuntary hospitalization is to address safety concerns and prevent harm.

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