Nursing Elites

1. A client, who is on a 30-day commitment to a drug rehabilitation unit, asks the nurse if he can go for a walk on the grounds of the treatment center. When he is told that his privileges do not include walking on the grounds, the client becomes verbally abusive. Which approach will the nurse take?

• A. Call a staff member to escort the client to his room.
• B. Tell the client to talk to his healthcare provider about his privileges.
• C. Remind the client of the unit rules.
• D. Ignore the client's inappropriate behavior.

Correct answer: C

Rationale: (C) is the correct approach in this situation as it reinforces unit rules, setting clear boundaries and expectations. By reminding the client of the unit rules, the nurse is helping to maintain a safe and structured environment within the drug rehabilitation unit. (A) is unnecessary since the client's behavior does not warrant immediate physical intervention. (B) is not ideal because the client's privileges have already been explained, and suggesting he speak to his healthcare provider may not address the immediate issue. (D) is not appropriate as addressing inappropriate behavior is essential in a therapeutic setting.

2. A 45-year-old male client tells the nurse that he used to believe that he was Jesus Christ, but now he knows he is not. Which response is best for the nurse to make?

• A. Did you really believe you were Jesus Christ?
• B. I think you're getting well.
• C. Others have had similar thoughts when under stress.
• D. Why did you think you were Jesus Christ?

Correct answer: C

Rationale: Choice C is the best response because it validates the client's experience by acknowledging that others have had similar thoughts when under stress. This response helps normalize the client's past experiences without judgment, fostering a supportive and empathetic environment. Choices A and D may come off as judgmental or confrontational, potentially making the client feel misunderstood or defensive. Choice B, 'I think you're getting well,' does not address the client's past belief or provide the understanding and validation that Choice C offers.

3. A 72-year-old female client is admitted to the psychiatric unit with a diagnosis of major depression. Which statement by the client should be of greatest concern to the nurse and require further assessment?

• A. "I will die if my cat dies."
• B. "I don't feel like eating this morning."
• C. "I just went to my friend's funeral."
• D. "Don't you have more important things to do?"

Correct answer: A

Rationale: Sometimes a client will use an analogy to describe themselves, and (A) would be an indication for conducting a suicide assessment. (B) could have a variety of etiologies, and while further assessment is indicated, this statement does not indicate potential suicide. The normal grief process differs from depression, and at this client's age, peer/cohort deaths are more frequent, so (C) would be within normal limits. (D) is an expression of low self-esteem typical of depression. Choices (B), (C), and (D) are examples of decreased energy and mood levels which would negate suicide ideation at this time.

4. A client with major depressive disorder is prescribed an SSRI. After one week, the client reports feeling no improvement in mood. What is the best response by the RN?

• A. It is common for antidepressants to take several weeks to have an effect.
• B. We may need to switch to a different medication.
• C. You should feel better by now, let's discuss this with your doctor.
• D. Maybe you are not taking the medication as prescribed.

Correct answer: A

Rationale: The correct response is A: 'It is common for antidepressants to take several weeks to have an effect.' This response is appropriate because SSRI and other antidepressants often require several weeks to exhibit improvement in mood. It is crucial to educate the client about this delay to manage expectations and promote adherence to the medication regimen. Choice B is incorrect as switching medications prematurely is not typically recommended after just one week. Choice C is incorrect because it sets unrealistic expectations for immediate improvement. Choice D is incorrect as it may come across as accusatory and should not be the initial response.

5. A LPN/LVN is performing a follow-up teaching session with a client discharged 1 month ago. The client is taking fluoxetine (Prozac). What information would be important for the nurse to obtain during this client visit regarding the side effects of the medication?

• A. Cardiovascular symptoms
• B. Gastrointestinal dysfunctions
• C. Problems with mouth dryness
• D. Problems with excessive sweating

Correct answer: B

Rationale: The correct answer is B: 'Gastrointestinal dysfunctions.' Fluoxetine commonly causes gastrointestinal side effects such as nausea, diarrhea, or constipation. These symptoms can significantly impact the client's quality of life and adherence to the medication regimen. Monitoring gastrointestinal issues is crucial for the nurse to ensure the client's well-being and optimize treatment outcomes. Choices A, C, and D are incorrect because cardiovascular symptoms, problems with mouth dryness, and problems with excessive sweating are not typically associated with fluoxetine use and are less likely to be a focus of concern during this client visit.

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