Nursing Elites

1. A client with bipolar disorder is experiencing a manic episode. Which nursing intervention is most appropriate?

• A. Encourage group activities to decrease isolation.
• B. Provide a structured environment with routine activities.
• C. Limit the client's physical activity to prevent exhaustion.
• D. Allow the client to choose activities freely.

Correct answer: B

Rationale: During a manic episode, individuals with bipolar disorder may exhibit excessive energy, impulsivity, and disorganized behavior. Providing a structured environment with routine activities is the most appropriate nursing intervention. This approach can help regulate the client's behavior, reduce impulsivity, and prevent engaging in potentially harmful activities. Encouraging group activities (Choice A) may exacerbate the client's symptoms due to overstimulation. Limiting physical activity (Choice C) may not address the need for structure and routine during a manic episode. Allowing the client to choose activities freely (Choice D) can lead to impulsive decision-making and may not provide the necessary boundaries required to manage the manic symptoms effectively.

2. A client with schizophrenia receiving haloperidol (Haldol) has a stiff, mask-like facial expression and difficulty speaking. What is the nurse's priority action?

• A. Administer a PRN dose of lorazepam (Ativan).
• B. Encourage the client to perform facial exercises.
• C. Notify the healthcare provider of possible extrapyramidal symptoms (EPS).
• D. Document the findings and continue to monitor the client.

Correct answer: C

Rationale: The correct answer is to notify the healthcare provider of possible extrapyramidal symptoms (EPS). The symptoms described, such as a stiff, mask-like facial expression and difficulty speaking, are indicative of EPS, which can be a serious side effect of haloperidol. It is crucial to involve the healthcare provider immediately to address these symptoms. Administering a PRN dose of lorazepam (Choice A) is not the priority in this situation, as it does not address the underlying cause of EPS. Encouraging the client to perform facial exercises (Choice B) is not appropriate and may not effectively manage EPS. Documenting the findings and continuing to monitor the client (Choice D) is important but not the priority when potential EPS is present; immediate action by notifying the healthcare provider is essential.

3. A 40-year-old male client diagnosed with schizophrenia and alcohol dependence has not had any visitors or phone calls since admission. He reports he has no family that cares about him and was living on the streets prior to this admission. According to Erikson's theory of psychosocial development, which stage is the client in at this time?

• A. Isolation.
• B. Stagnation.
• C. Despair.
• D. Role confusion.

Correct answer: B

Rationale: The client is in Erikson's 'Generativity vs. Stagnation' stage (age 24 to 45). This stage involves maintaining intimate relationships and moving toward developing a family, which the client seems to be struggling with due to lack of visitors and family support. Choices (A), (C), and (D) are incorrect. Isolation typically occurs in young adulthood (age 18 to 25), Despair in maturity (age 45 to death), and Role confusion in adolescence (age 12 to 20). These stages reflect challenges individuals face if they do not successfully navigate their psychosocial developmental tasks.

4. A nurse working on a mental health unit receives a community call from a person who is tearful and states, 'I just feel so nervous all of the time. I don't know what to do about my problems. I haven't been able to sleep at night and have hardly eaten for the past 3 or 4 days.' The nurse should initiate a referral based on which assessment?

• A. Altered thought processes.
• B. Moderate levels of anxiety.
• C. Inadequate social support.
• D. Altered health maintenance.

Correct answer: B

Rationale: The nurse should initiate a referral based on moderate levels of anxiety (B) as the client reports feeling nervous all the time, sleep disturbances, poor appetite, and difficulty solving problems. These symptoms are indicative of significant anxiety levels. The client does not mention symptoms related to altered thought processes (A) or inadequate social support (C). There is insufficient information to suggest altered health maintenance (D) as a reason for referral in this scenario.

5. A client with a history of substance abuse is admitted to the hospital for detoxification. What is the most important intervention for the LPN/LVN to implement?

• A. Monitor the client for signs of withdrawal.
• B. Encourage the client to express feelings about substance use.
• C. Provide the client with information about support groups.
• D. Administer prescribed medications to manage withdrawal symptoms.

Correct answer: D

Rationale: Administering prescribed medications to manage withdrawal symptoms is the priority intervention for a client undergoing detoxification. This intervention aims to prevent severe complications that may arise during the detox process. Monitoring for signs of withdrawal (choice A) is important but providing immediate medical management through medications takes precedence to ensure the client's safety. Encouraging the client to express feelings (choice B) and providing information about support groups (choice C) are essential aspects of care but are not as urgent as administering medications to manage withdrawal symptoms.

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