Nursing Elites

1. A client with bipolar disorder is prescribed lithium. Which dietary instruction should the nurse provide?

• A. Avoid foods high in potassium.
• B. Increase intake of caffeinated beverages.
• C. Maintain consistent sodium intake.
• D. Follow a low-protein diet.

Correct answer: C

Rationale: The correct instruction for a client with bipolar disorder prescribed lithium is to maintain consistent sodium intake. Fluctuations in sodium levels can impact lithium levels, potentially leading to toxicity. Therefore, it is crucial to advise the client to keep their sodium intake consistent to ensure the effectiveness and safety of the lithium therapy. Choices A, B, and D are incorrect. Avoiding foods high in potassium is not directly related to lithium therapy. Increasing intake of caffeinated beverages can interfere with the action of lithium. Following a low-protein diet is not a standard recommendation for clients prescribed lithium.

2. A client is experiencing a panic attack. Which action should the nurse take first?

• A. Remain with the client and offer reassurance.
• B. Administer an anti-anxiety medication as prescribed.
• C. Encourage the client to engage in physical activity.
• D. Encourage the client to breathe deeply and slowly.

Correct answer: A

Rationale: During a panic attack, the immediate priority for the nurse is to provide support and reassurance to the client. Remaining with the client helps establish a sense of safety and trust, which can help calm the client during an episode of panic. Administering medication, encouraging physical activity, and deep breathing techniques are beneficial interventions, but offering reassurance and support should be the initial step to address the immediate emotional distress and anxiety experienced by the client.

3. When an individual uses the defense mechanism of displacement after the boss openly disagrees with suggestions, what behavior would be expected from this individual?

• A. The individual assertively confronts the boss
• B. The individual leaves the staff meeting to work out in the gym
• C. The individual criticizes a coworker
• D. The individual takes the boss out to lunch

Correct answer: C

Rationale: The correct answer is C. The individual using the defense mechanism of displacement would criticize a coworker after being confronted by the boss. Displacement involves transferring feelings from one target to a neutral or less-threatening target, hence the individual criticizing a coworker instead of directly confronting the boss. Choices A, B, and D are incorrect. Choice A is incorrect because the individual is not likely to assertively confront the boss when using displacement. Choice B is incorrect as leaving the meeting to work out in the gym is not a typical response when displacement is used. Choice D is incorrect as taking the boss out to lunch does not align with the concept of displacement, which involves redirecting emotions onto another target.

4. Kyle, a patient with schizophrenia, began taking the first-generation antipsychotic haloperidol (Haldol) last week. One day you find him sitting very stiffly and not moving. He is diaphoretic, and when you ask if he is okay, he seems unable to respond verbally. His vital signs are: BP 170/100, P 110, T 104.2°F. What is the priority nursing intervention? Select one that does not apply.

• A. Hold his medication and contact his prescriber.
• B. Wipe him with a washcloth wet with cold water or alcohol.
• C. Administer a medication such as benztropine IM to correct this dystonic reaction.
• D. Reassure him that although there is no treatment for his tardive dyskinesia, it will pass.

Correct answer: C

Rationale: The patient's symptoms, including stiffness, diaphoresis, inability to respond verbally, and vital sign abnormalities, are indicative of neuroleptic malignant syndrome (NMS), a serious and potentially life-threatening side effect of antipsychotic medications. Administering a medication such as benztropine intramuscularly is the priority to address the dystonic reaction associated with NMS. This intervention can help alleviate symptoms and prevent further complications. Holding the medication and contacting the prescriber may be necessary but addressing the acute symptoms takes precedence. Wiping the patient with a cold washcloth or alcohol would not address the underlying medical emergency. Reassuring the patient about tardive dyskinesia is irrelevant and not the immediate concern in this scenario.

5. A client with generalized anxiety disorder (GAD) is being discharged. Which of the following instructions should the nurse include in the discharge teaching? Select one that does not apply.

• A. Practice relaxation techniques daily
• B. Avoid caffeine and alcohol
• C. Engage in regular physical activity
• D. Use benzodiazepines as the first line of treatment

Correct answer: D

Rationale: When discharging a client with GAD, it is important to provide instructions that promote holistic well-being and support without exacerbating the condition. Practicing relaxation techniques daily, avoiding caffeine and alcohol, and engaging in regular physical activity can help manage anxiety symptoms effectively. These strategies focus on self-care and healthy lifestyle choices. Seeking support from friends and family also plays a crucial role in maintaining mental health. However, using benzodiazepines as the first line of treatment is not recommended due to their potential for dependence and other associated risks. Non-pharmacological interventions and therapy are usually preferred as initial approaches in managing GAD. Therefore, the option 'D: Use benzodiazepines as the first line of treatment' is incorrect and should not be included in the discharge teaching for a client with GAD.

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