Nursing Elites

1. A client with a history of bipolar disorder is stabilized on a mood stabilizer and has been prescribed lamotrigine (Lamictal). Which outcome indicates that the medication is effective?

• A. Decrease in manic episodes.
• B. Improvement in depressive symptoms.
• C. Reduction in anxiety symptoms.
• D. Increased sleep duration.

Correct answer: B

Rationale: The correct answer is B: Improvement in depressive symptoms. Lamotrigine is commonly used as a mood stabilizer and is particularly effective in managing depressive symptoms in bipolar disorder. While it may also help with preventing manic episodes, its primary indication is for treating depressive symptoms. Choices A, C, and D are incorrect because lamotrigine is not specifically indicated for reducing manic episodes, anxiety symptoms, or increasing sleep duration in bipolar disorder.

2. A client with a history of substance abuse is admitted to the hospital for treatment of a new illness. Which of the following is the most important to assess upon admission?

• A. History of recent drug use.
• B. Current employment status.
• C. Family history of mental illness.
• D. Recent weight changes.

Correct answer: A

Rationale: Assessing the history of recent drug use is crucial when admitting a client with a history of substance abuse. Understanding recent drug use helps in managing potential withdrawal symptoms, preventing drug interactions with the new treatment, and ensuring appropriate care. Assessing current employment status (choice B) is important for social and financial support but is not as crucial as assessing recent drug use in this scenario. Family history of mental illness (choice C) and recent weight changes (choice D) are also important aspects of assessment but are not as immediate and critical as evaluating recent drug use in a client with a history of substance abuse.

3. A female high school teacher who was a child of alcoholic parents seeks counseling at the community health clinic because of depression over a student who was killed by a drunk driver. After several weeks of counseling, which client behavior is the best indicator that the client is coping well with anxiety related to the student’s death?

• A. Signs a safety contract with the nurse agreeing not to hurt herself or others
• B. Confronts her parents about the hurt she felt as a child of alcoholic parents
• C. Becomes the faculty sponsor for Students Against Drunk Driving (SADD)
• D. Describes her feelings about the student’s death in detail

Correct answer: C

Rationale: Becoming the faculty sponsor for Students Against Drunk Driving (SADD) is the best indicator that the client is coping well with anxiety related to the student’s death. This choice demonstrates active involvement in preventing similar tragedies, showing that the client is channeling her emotions into positive action and advocacy. Option A, signing a safety contract, is important for safety but does not directly address coping with the anxiety related to the student's death. Option B, confronting her parents about past hurt, may be beneficial for personal growth but does not directly reflect coping with the current situation. Option D, describing feelings in detail, is a positive step in therapy but does not necessarily indicate coping well with the anxiety related to the student's death.

4. A female client, who is wearing dirty clothes and has a foul body odor, comes to the clinic reporting feeling scared because she is being stalked. What should the nurse do first?

• A. Offer the client a safe place to relax before interviewing her.
• B. Ask the client to describe why she is being stalked.
• C. Recommend that the client talk with a social worker.
• D. Assure the client that the healthcare provider will see her today.

Correct answer: A

Rationale: When a client presents with signs of distress and potential safety concerns, the priority is to provide a safe environment. Offering a safe place to relax can help the client feel secure and ready for further assessment and support. This action allows the nurse to establish rapport, ensure the client's immediate safety, and create a trusting relationship before delving into the details of the situation. Asking the client to describe why she is being stalked (Choice B) may exacerbate her distress and should come after ensuring her safety. Recommending that the client talk with a social worker (Choice C) is important but should follow immediate safety measures. Assuring the client that the healthcare provider will see her today (Choice D) is less critical than addressing her safety concerns and emotional state.

5. Which factors tend to increase the difficulty of diagnosing young children who demonstrate behaviors associated with mental illness? Select all that apply.

• A. Limited language skills
• B. Level of cognitive development
• C. Level of emotional development
• D. Parental denial that a problem exists

Correct answer: B

Rationale: The correct answer is B: Level of cognitive development. The level of cognitive development is a crucial factor that can complicate the diagnosis of mental illness in young children. Young children may not have fully developed cognitive abilities to express their symptoms or understand diagnostic procedures, making it challenging for healthcare providers to assess their mental health accurately. Limited language skills (choice A) can hinder communication but are not as significant as cognitive development in diagnosing mental illness. Emotional development (choice C) is important but may not be as directly linked to the diagnostic challenges as cognitive development. Parental denial (choice D), although a potential barrier, is not a factor inherent to the child's characteristics affecting the diagnostic process.

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