Nokea
When the nurse who was not promoted first read the memo and learned that the other nurse had received the promotion, she left the room in tears. This behavior is an example of:
- A. conversion.
- B. regression
- C. introjection.
- D. rationalization
Correct Answer: B
Rationale: Crying is a regressive behavior. The ego returned to an earlier, comforting, and less-mature way of behaving in the face of disappointment. Regression involves reverting to an earlier stage of development to cope with stress or conflict. In this scenario, the nurse regressed to a childlike state by crying when faced with the disappointment of not getting the promotion, demonstrating regression as a defense mechanism. Conversion involves transforming anxiety into a physical symptom. Introjection involves unconsciously identifying intensely with another person. Rationalization involves unconsciously creating acceptable explanations to justify unacceptable ideas, actions, or feelings. Therefore, the correct answer is regression as it aligns with the nurse's behavior of regressing to a childlike state by crying due to the disappointment of not receiving the promotion.
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Which of the following factors can impact an individual's ability to give informed consent?
- A. IQ
- B. educational level
- C. pain medications
- D. financial status
Correct Answer: C
Rationale: Pain medications might alter alertness, thought processes, and reactions, potentially impacting an individual's ability to give informed consent. It is recommended to approach a client for consent at least 4 hours after the last dose of pain medicine to minimize any influence. Choices A, B, and D are incorrect. While IQ and educational level may affect how information is presented during the discussion process, they do not directly impact informed-consent decision-making. Financial status is also not a direct factor in an individual's ability to provide informed consent, unlike pain medications which can directly affect cognitive functions and decision-making abilities.
Activities of effective supervisors can be task-related or people-related activities. An example of a task-related supervisory activity is:
- A. coaching.
- B. evaluating.
- C. delegating.
- D. facilitating.
Correct Answer: C
Rationale: Delegating is the act of assigning work to those capable and competent to do the work, making it a task-related supervisory activity. Coaching, evaluating, and facilitating are people-related supervisory activities. Coaching involves guiding and developing individuals, evaluating entails assessing performance, and facilitating focuses on enabling tasks and processes. These activities are more centered on interacting with and supporting people rather than directly assigning tasks. Therefore, in the context of task-related activities, delegating stands out as the correct choice.
Why might the physician order antibiotics to be given through the central venous access device (CVAD) rather than through a peripheral IV line if the CVAD becomes infected?
- A. To prevent infiltration of the peripheral line
- B. To reduce the pain and discomfort associated with antibiotic administration in a small vein
- C. To lessen the chance of an allergic reaction to the antibiotic
- D. To attempt to eliminate microorganisms in the catheter and prevent having to remove it
Correct Answer: D
Rationale: When a patient's central venous access device (CVAD) becomes infected, administering antibiotics through the line is essential to attempt to eliminate microorganisms within the catheter. The goal is to prevent the necessity of removing the catheter, which might be required if the infection persists. Choice A, 'To prevent infiltration of the peripheral line,' is incorrect as the priority is addressing the catheter infection, not preventing issues with a peripheral line. Choice B, 'To reduce the pain and discomfort associated with antibiotic administration in a small vein,' is not relevant to the rationale for choosing the CVAD for antibiotic administration. Choice C, 'To lessen the chance of an allergic reaction to the antibiotic,' is also incorrect as the main focus is managing the catheter-associated infection rather than allergy prevention.
The nurse suspects an elderly client has been the victim of abuse. The client denies abuse and declines assistance. The nurse's next action should be to:
- A. respect the client's decision to refuse assistance.
- B. report the incident to the authorities.
- C. arrange an appointment with the client's family.
- D. educate the client about available services.
Correct Answer: D
Rationale: In cases where elderly clients deny abuse and refuse assistance, it is crucial for the nurse to respect their autonomy while also ensuring their safety. Educating the client about available services is the appropriate action as it empowers the client with information without imposing any decisions on them. It allows the client to make informed choices regarding their well-being. Reporting the incident to the authorities (Choice B) may be necessary if there is immediate danger, but in this scenario, the client denies abuse. Arranging an appointment with the client's family (Choice C) may not be appropriate without the client's consent or in cases where the family might be involved in the abuse. Simply doing nothing (Choice A) is not the best course of action as the nurse should still provide support and resources to the client.
The client is taking rifampin 600mg po daily to treat his tuberculosis. Which action by the nurse indicates understanding of the medication?
- A. Telling the client that the medication will need to be taken with juice
- B. Telling the client that the medication will change the color of the urine
- C. Telling the client to take the medication before going to bed at night
- D. Telling the client to take the medication if night sweats occur
Correct Answer: B
Rationale: The correct answer is telling the client that the medication will change the color of the urine. Rifampin can change the color of the urine and body fluid. Teaching the client about these changes is important as the client might think this is a complication. Answer A is incorrect because there is no specific requirement to take rifampin with juice. Answer C is incorrect because rifampin should be taken at consistent times, not necessarily before going to bed. Answer D is incorrect as rifampin should be taken regularly as prescribed, not based on symptoms like night sweats.