Nursing Elites

1. A client diagnosed with generalized anxiety disorder (GAD) states, 'I just can't stop worrying about everything.' Which nursing diagnosis is most appropriate for this client?

• A. Ineffective coping
• B. Disturbed thought processes
• C. Chronic low self-esteem
• D. Social isolation

Correct answer: A

Rationale: The most appropriate nursing diagnosis for a client with generalized anxiety disorder (GAD) who expresses an inability to stop worrying about everything is 'Ineffective coping.' This diagnosis indicates the client's struggle to manage anxiety and worry effectively, which aligns with the client's statement. 'Disturbed thought processes' (Choice B) would involve disorganized or irrational thinking patterns, which are not directly related to the client's statement about excessive worry. 'Chronic low self-esteem' (Choice C) refers to a long-standing negative self-evaluation and is not the most fitting diagnosis for the client's current concern. 'Social isolation' (Choice D) pertains to a lack of social interactions and support, which is not the primary issue highlighted by the client's statement.

2. A client with bipolar disorder is experiencing a manic episode. Which intervention should the nurse implement to ensure the client's safety?

• A. Provide a structured environment with minimal stimuli.
• B. Monitor the client closely for signs of exhaustion.
• C. Encourage the client to rest and sleep as needed.
• D. Encourage the client to engage in regular physical activity.

Correct answer: A

Rationale: During a manic episode in bipolar disorder, individuals may exhibit increased energy levels, impulsivity, and reduced need for sleep, which can lead to risky behaviors and accidents. Providing a structured environment with minimal stimuli helps to reduce the risk of overstimulation and impulsive actions, thereby promoting the client's safety. This intervention aims to create a calm and controlled setting that can prevent potential harm to the client during this phase of the disorder.

3. A patient with schizophrenia is prescribed clozapine. Which potential side effect requires regular monitoring?

• A. Weight loss
• B. Hypertension
• C. Agranulocytosis
• D. Hyperthyroidism

Correct answer: C

Rationale: When a patient with schizophrenia is prescribed clozapine, regular monitoring for agranulocytosis is essential. Agranulocytosis is a severe reduction in white blood cells that can be life-threatening. Monitoring white blood cell counts is crucial to detect this side effect early and prevent serious complications. Weight loss (Choice A) is not a common side effect of clozapine. Hypertension (Choice B) and hyperthyroidism (Choice D) are also not typically associated with clozapine use, making them incorrect choices for regular monitoring.

4. Devastated by a divorce from an abusive husband, a wife completes grief counseling. Which statement by the wife should indicate to a nurse that the client is in the acceptance stage of grief?

• A. If only we could have tried again, things might have worked out.
• B. I am so mad that the children and I had to put up with him as long as we did.
• C. Yes, it was a difficult relationship, but I think I have learned from the experience.
• D. I still don't have any appetite and continue to lose weight.

Correct answer: C

Rationale: The nurse should recognize that the client is in the acceptance stage of grief based on the statement 'Yes, it was a difficult relationship, but I think I have learned from the experience.' In this statement, the client is acknowledging the difficulty of the relationship but also expressing personal growth and learning from the experience, indicating acceptance. Choices A, B, and D do not reflect the acceptance stage of grief. Choice A shows a sense of regret and a wish for things to have turned out differently. Choice B demonstrates lingering anger towards the ex-husband. Choice D suggests ongoing physical manifestations of grief like loss of appetite and weight loss, which are more indicative of earlier stages of grief.

5. During a mental status examination, which of the following components should not be included in the assessment?

• A. Appearance and behavior
• B. Giving advice
• C. Mood and affect
• D. Cognitive function

Correct answer: B

Rationale: During a mental status examination, components such as appearance and behavior, mood and affect, and cognitive function are assessed. Giving advice is not a component of a mental status examination as it focuses on evaluating the client's mental state rather than providing guidance or recommendations.

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