Nursing Elites

1. When explaining suicide precautions to a client, what would be the best explanation?

• A. You need to control yourself. If you cannot, we will do it for you.
• B. This can seem embarrassing, but we want you to be safe.
• C. You will stay on these precautions for one week.
• D. When you feel you are safer, then we will not need to observe you.

Correct answer: D

Rationale: Choice D provides a supportive and empowering explanation to the client on suicide precautions. It emphasizes the client's own sense of safety and control, indicating that the observation is temporary and can be removed when the client feels safer. This approach promotes autonomy and encourages the client to actively participate in their own well-being, fostering a therapeutic relationship based on trust and collaboration.

2. A client diagnosed with borderline personality disorder has been admitted to the psychiatric unit after a suicide attempt. Which of the following actions should the nurse take first?

• A. Encourage the client to express feelings about the suicide attempt.
• B. Place the client on one-to-one observation.
• C. Discuss the client's feelings about the suicide attempt.
• D. Encourage the client to participate in group therapy.

Correct answer: B

Rationale: The initial priority for the nurse is to ensure the safety of the client. Placing the client on one-to-one observation allows for constant monitoring and intervention if there are any signs of self-harm or a worsening condition. This immediate intervention is crucial to prevent further harm. Options A, C, and D involve therapeutic communication and interventions, which are important but should come after ensuring the client's safety.

3. Pablo is a homeless adult who has no family connection. Pablo passed out on the street, and emergency medical services took him to the hospital where he expresses a wish to die. The physician recognizes evidence of substance use problems and mental health issues and recommends inpatient treatment for Pablo. What is the rationale for this treatment choice? Select one that doesn't apply.

• A. Intermittent supervision is available in inpatient settings.
• B. He requires stabilization of multiple symptoms.
• C. How do you feel about talking to a mental health counselor?
• D. Medication adherence will be mandated.

Correct answer: D

Rationale: The correct answer is D because medication adherence being mandated is not a primary rationale for inpatient treatment. The main reasons for recommending inpatient treatment in this scenario include the need for stabilization of multiple symptoms, addressing nutritional and self-care needs, and ensuring safety due to the imminent danger of self-harm. Inpatient settings provide a more intensive level of care and supervision to address these complex issues effectively.

4. Which client action is an example of the defense mechanism of sublimation?

• A. A woman channels her energy into a new hobby after a breakup.
• B. A man redirects his anger from work into a workout routine.
• C. A student focuses on studying to avoid thinking about a recent argument.
• D. An athlete channels competitive impulses into a successful sports career.

Correct answer: B

Rationale: Sublimation is a defense mechanism where unacceptable impulses are redirected into socially acceptable activities. In this scenario, the man redirects his anger from work into a workout routine, which is a positive and constructive way of managing his emotions. Choices A, C, and D do not fully align with sublimation as they do not involve redirecting unacceptable impulses into socially acceptable outlets, unlike the man's action in choice B.

5. Tammy, a 28-year-old with major depressive disorder and bulimia nervosa, is ready for discharge from the county hospital after 2 weeks of inpatient therapy. Tammy is taking citalopram (Celexa) and reports that it has made her feel more hopeful. With a secondary diagnosis of bulimia nervosa, what is an alternative antidepressant to consider?

• A. Fluoxetine (Prozac)
• B. Isocarboxazid (Marplan)
• C. Amitriptyline
• D. Duloxetine (Cymbalta)

Correct answer: A

Rationale: Fluoxetine (Prozac) is a suitable alternative antidepressant for Tammy due to its approval for the treatment of bulimia nervosa. It belongs to the selective serotonin reuptake inhibitor (SSRI) class of antidepressants, similar to citalopram, which Tammy is already taking. Fluoxetine has shown efficacy in treating bulimia nervosa and can be a beneficial choice for individuals with this condition.

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