Nursing Elites

1. A client diagnosed with bipolar disorder tells the nurse that she wants to stop taking her lithium. She states, 'I feel fine, and I don't think I need it anymore.' What should the nurse do first?

• A. Agree with the client that she seems fine now.
• B. Remind the client of the importance of lithium.
• C. Ask the healthcare provider to discontinue the lithium prescription.
• D. Arrange for a psychiatric evaluation for the client.

Correct answer: B

Rationale: When a client with bipolar disorder expresses a desire to stop taking lithium because they feel fine, the nurse's initial action should be to remind the client of the importance of lithium. This approach helps educate the client about the necessity of medication adherence in managing bipolar disorder. Agreeing with the client or immediately arranging a psychiatric evaluation may not address the root issue of medication non-adherence. Asking the healthcare provider to discontinue the prescription without further assessment and intervention could potentially jeopardize the client's stability and treatment plan.

2. A female client with major depression is prescribed fluoxetine (Prozac). She reports experiencing increased energy but still feels sad and hopeless. What is the nurse's best response?

• A. ''These feelings are normal and will pass with time.''
• B. ''Increased energy can sometimes lead to increased risk for self-harm.''
• C. ''The medication needs more time to be effective.''
• D. ''Let's talk about the things that make you feel this way.''

Correct answer: B

Rationale: The correct answer is B. Increased energy without improvement in mood can increase the risk of self-harm in clients with depression. It is crucial for the nurse to recognize this potential risk and closely monitor the client for any signs of self-harm. Choice A is incorrect because dismissing the client's persistent feelings of sadness and hopelessness as normal may invalidate her experiences. Choice C is incorrect as fluoxetine (Prozac) typically starts showing effectiveness within a few weeks, so further delay is concerning. Choice D is incorrect because while discussing the client's feelings is important, the immediate focus should be on addressing the potential risk of self-harm associated with increased energy.

3. What are neurotransmitters?

• A. Chemical messengers that cause brain cells to turn on or off.
• B. Areas of the brain that are responsible for controlling emotions.
• C. Clumps of cells that alert the other brain cells to receive messages.
• D. Web-like structures that provide connections among parts of the brain.

Correct answer: A

Rationale: Neurotransmitters are chemicals in the brain that act as messengers between neurons, influencing various psychological functions. Choice A correctly defines neurotransmitters by stating that they are chemical messengers that cause brain cells to turn on or off. This is the function of neurotransmitters in transmitting signals between neurons. Choices B, C, and D are incorrect because they do not accurately describe neurotransmitters and their role in the brain.

4. The wife of a client diagnosed with paranoid schizophrenia visits 2 days after her husband's admission and states to the nurse, 'Why isn't he eating? He's still talking about his food being poisoned.' Which of the following appraisals by the LPN/LVN is most accurate?

• A. The wife's inquiry is reasonable.
• B. Education about her husband's medication is needed.
• C. Her expectations of her husband are realistic.
• D. An increase in the client's medication is needed.

Correct answer: B

Rationale: The correct answer is B. The wife needs education about her husband's medication to understand how it affects his perceptions, including paranoid thoughts about food. Choice A is incorrect because the wife's inquiry reflects her lack of understanding of the situation rather than being reasonable. Choice C is incorrect as the husband's condition requires specialized care beyond what the wife might consider realistic. Choice D is incorrect as increasing medication should not be the immediate response; education and reassurance are key in this situation.

5. A client with bipolar disorder is being treated with lithium. The nurse should monitor the client for which early sign of lithium toxicity?

• A. Diarrhea
• B. Tremors
• C. Polyuria
• D. Blurred vision

Correct answer: A

Rationale: Corrected Rationale: Diarrhea is an early sign of lithium toxicity. When a client being treated with lithium presents with diarrhea, it can indicate the beginning of lithium toxicity. Monitoring for this symptom is crucial as it can progress to more severe toxicity if not addressed promptly. Tremors (choice B) are more commonly associated with the therapeutic effects of lithium rather than toxicity. Polyuria (choice C) is a common side effect of lithium, but it is not typically an early sign of toxicity. Blurred vision (choice D) is not a common early sign of lithium toxicity. Therefore, option A is the correct answer.

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