Nursing Elites

1. A client with alcohol use disorder is being treated in a rehabilitation facility. Which behavior indicates that the client is making progress in recovery?

• A. Attends all scheduled therapy sessions regularly.
• B. Is participating in group therapy and sharing experiences.
• C. Completes a work-study program.
• D. Has a decreased need for psychiatric medication.

Correct answer: B

Rationale: The correct answer is B. Participation in group therapy and sharing experiences is a positive sign of progress in recovery for a client with alcohol use disorder. It fosters peer support, allows for personal insight, and encourages social interaction, which are essential aspects of the recovery process. Attending all scheduled therapy sessions regularly (Choice A) is important but may not necessarily indicate the same level of progress as active participation in group therapy. Completing a work-study program (Choice C) is not directly related to the client's recovery from alcohol use disorder. Having a decreased need for psychiatric medication (Choice D) is not necessarily a reliable indicator of progress in recovery from alcohol use disorder, as medication management is a separate aspect of treatment.

2. What intervention is best for the nurse to implement for a male client with schizophrenia who is demonstrating echolalia, which is becoming annoying to other clients on the unit?

• A. Avoid acknowledging the behavior.
• B. Isolate the client from other clients.
• C. Administer a PRN sedative.
• D. Escort the client to his room.

Correct answer: D

Rationale: Echolalia, the constant repetition of what others are saying, can be disruptive to the therapeutic environment. The most appropriate intervention is to escort the client to his room. This action provides the client with a private space where he can engage in the behavior without disturbing other clients. Avoiding acknowledgment of the behavior (Choice A) may not address the issue and could lead to increased annoyance among other clients. Isolating the client (Choice B) may have negative psychological effects and should be avoided unless absolutely necessary for safety concerns. Administering a PRN sedative (Choice C) should be considered only as a last resort and if other de-escalation techniques have been unsuccessful.

3. A client who is admitted with a closed head injury after a fall has a blood alcohol level (BAL) of 0.28 (28%) and is difficult to arouse. Which intervention during the first 6 hours following admission should the nurse identify as the priority?

• A. Place in a side-lying position with head of bed elevated.
• B. Administer disulfiram (Antabuse) immediately
• C. Give lorazepam (Ativan) PRN for signs of withdrawal.
• D. Provide thiamine and folate supplements as prescribed.

Correct answer: A

Rationale: Maintain the patient's airway is the priority for a client who is intoxicated and obtunded.

4. 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.

5. A young adult male is hospitalized due to depression and an attempted suicide. The client reports that he lost his job and was angry with his employer for firing him when he took an overdose of pain medications. Which behavior best indicates to the nurse that his condition is improving?

• A. Initiates interactions with other clients.
• B. Describes verbally when he is angry.
• C. Participates in a job search with a social worker.
• D. Denies plans to harm himself or others.

Correct answer: A

Rationale: The best indicator of improvement in a client with depression is initiating interactions with others. This behavior demonstrates that the client is becoming less withdrawn and more self-directed, showing an improvement in social engagement and coping mechanisms. Choice B, describing anger verbally, may show some progress in emotional expression but does not necessarily indicate overall improvement in depression. Choice C, participating in a job search with a social worker, may be positive but does not directly address social interactions, which are crucial for improving depression. Choice D, denying plans to harm himself or others, is important for safety but does not directly reflect improvement in the client's social functioning or coping skills.

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