Nursing Elites

1. While explaining an illness to a 10-year-old, what should the nurse keep in mind about cognitive development at this age?

• A. They are able to make simple associations of ideas.
• B. They are able to think logically in organizing facts.
• C. Interpretation of events originates from their own perspective.
• D. Conclusions are based on previous experiences.

Correct answer: B

Rationale: The correct answer is that 10-year-olds are able to think logically in organizing facts. At this age, children are in the concrete operational stage according to Piaget's theory of cognitive development. In this stage, they can understand and organize information logically and can manipulate objects mentally. Choice A is incorrect because simple associations of ideas are more characteristic of earlier developmental stages. Choice C is incorrect as it refers to egocentrism, which is more typical of the preoperational stage. Choice D is incorrect as basing conclusions on previous experiences is a broader concept that applies across different ages and stages of development, rather than being specific to 10-year-olds in the concrete operational stage.

2. A neonate born at 32 weeks' gestation and weighing 3 lb (1361 g) is admitted to the neonatal intensive care unit (NICU). When would the nurse take the neonate's mother to visit the infant?

• A. When the infant's condition has stabilized
• B. When the infant is out of immediate danger
• C. When the primary health care provider has provided written permission
• D. When the mother is well enough to be taken to the NICU

Correct answer: D

Rationale: The mother should see her infant as soon as possible to acknowledge the reality of the birth and begin bonding. Delaying the visit may impede maternal-infant bonding. The timing of the mother's visit should be based on her physical and emotional readiness, not solely on the infant's condition or the need for written permission. The nurse can independently facilitate the mother's visit without requiring a prescription from the primary healthcare provider.

3. After 5 years of unprotected intercourse, a childless couple comes to the fertility clinic. The husband tells the nurse that his parents have promised to make a down payment on a house for them if his wife gets pregnant this year. Which response would the nurse provide?

• A. ''This must be very difficult for you with this added pressure.''
• B. 'Having a child is a decision you should make without your parents' input.''
• C. 'You're lucky. It's nice that your parents are making such a generous offer.''
• D. ''Five years without a pregnancy is a long time. You were right to come to the fertility clinic.''

Correct answer: A

Rationale: The correct response acknowledges the emotional challenge the couple is facing due to the added pressure of the incentive from the husband's parents. By expressing empathy and understanding, the nurse encourages the couple to open up about their feelings and concerns. Choice B is not the best response as it dismisses the husband's situation and fails to address the emotional impact of the added pressure. Choice C focuses on the parents' offer rather than the couple's emotional state, which is not the primary concern in this situation. Choice D, mentioning the duration of infertility, may come across as insensitive and may hinder open communication by potentially making the couple feel judged or discouraged.

4. A client's blood pressure reading is 156/94 mm Hg. Which action should the nurse take first?

• A. Inform the client that the blood pressure is high and compare the reading with the client's previously documented blood pressure readings for accuracy.
• B. Contact the health care provider to report the reading and obtain a prescription for an antihypertensive medication.
• C. Replace the cuff with a larger one to ensure a proper fit for the client and increase arm comfort during blood pressure measurement.
• D. Compare the current reading with the client's previously documented blood pressure readings.

Correct answer: D

Rationale: The correct action for the nurse to take first when a client's blood pressure reading is 156/94 mm Hg is to compare the current reading with the client's previously documented readings. This comparison helps determine whether the current reading is abnormal for the client. Option A, which involves informing the client that the blood pressure is high and comparing it with the previous readings, is appropriate as it educates the client and aids in accurate assessment. Option B, contacting the health care provider for medication, is premature without further assessment. Option C, replacing the cuff with a larger one, is incorrect as it may affect the accuracy of the blood pressure measurement and is not a standard practice for managing high blood pressure readings.

5. During a discussion about glaucoma at the community center, which comment by one of the retirees would the nurse give a supportive comment to reinforce correct information?

• A. ''I usually avoid driving at night since lights sometimes seem to make things blur.''
• B. ''I take half of the usual dose for my sinuses to maintain my blood pressure.''
• C. ''I have to sit at the side of the pool with the grandchildren since I can't swim with this eye problem.''
• D. ''I take extra fiber and drink lots of water to avoid getting constipated.''

Correct answer: D

Rationale: The correct answer is ''I take extra fiber and drink lots of water to avoid getting constipated.'' In individuals with glaucoma, activities that involve straining, such as constipation, should be avoided as they can increase intraocular pressure. Choices A, B, and C are incorrect as they do not align with the management of glaucoma. Driving at night or taking sinus medication are not directly related to glaucoma, and sitting by the pool due to an eye problem does not provide information relevant to managing glaucoma.

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