Nursing Elites

1. A client with bipolar disorder is prescribed valproic acid (Depakote). What is the most important laboratory test for the LPN/LVN to monitor?

• A. Liver function tests.
• B. Kidney function tests.
• C. Thyroid function tests.
• D. Complete blood count.

Correct answer: A

Rationale: The correct answer is A: Liver function tests. Monitoring liver function tests is crucial for clients prescribed valproic acid (Depakote) due to the medication's potential to affect liver function and increase the risk of liver toxicity. While kidney function tests (choice B), thyroid function tests (choice C), and complete blood count (choice D) are important in various clinical scenarios, the priority when administering valproic acid is to monitor liver function to prevent adverse effects associated with this medication.

2. What information should the nurse include in the client's teaching about starting a selective serotonin reuptake inhibitor (SSRI) for major depressive disorder?

• A. It may take several weeks for the medication to take effect.
• B. You can stop taking the medication once you feel better.
• C. Avoid foods high in tyramine while on this medication.
• D. You should expect an immediate improvement in mood.

Correct answer: A

Rationale: The correct answer is A: "It may take several weeks for the medication to take effect." SSRIs typically take several weeks to reach their full effect, and it's important to set realistic expectations for the client. Choice B is incorrect because stopping the medication abruptly can lead to withdrawal symptoms and worsening of depression. Choice C is unrelated to SSRI therapy and pertains more to MAOIs. Choice D is incorrect as SSRIs do not provide immediate improvement in mood; rather, they require time to exert their therapeutic effects.

3. A nurse determines that the wife of an alcoholic client is benefitting from attending an Al-Anon group when the nurse hears the wife say:

• A. I no longer feel that I deserve the meetings my husband inflicts on me.
• B. My attendance at the meetings has helped me to see that I provoke my husband's violence.
• C. I enjoy attending the meetings because they get me out of the house and away from my husband.
• D. I can tolerate my husband's destructive behaviors now that I know they are common with alcoholics.

Correct answer: A

Rationale: Choice A is the correct answer as the statement indicates the wife understands that her husband's behavior is not her fault and is benefitting from the group support. Choice B is incorrect as it suggests self-blame rather than recognizing the husband's responsibility. Choice C is incorrect as the benefit is related to emotional support and understanding, not just getting away from the husband. Choice D is incorrect as tolerating destructive behaviors is not a healthy outcome of attending support groups.

4. A male client is admitted to the mental health unit because he was feeling depressed about the loss of his wife and job. The client has a history of alcohol dependency and admits that he was drinking alcohol 12 hours ago. Vital signs are: temperature, 100 F, pulse 100, and BP 142/100. The nurse plans to give the client lorazepam (Ativan) based on which priority nursing diagnosis?

• A. Risk for injury related to suicidal ideation.
• B. Risk for injury related to alcohol detoxification.
• C. Knowledge deficit related to ineffective coping.
• D. Health-seeking behaviors related to personal crisis.

Correct answer: B

Rationale: The most important nursing diagnosis is related to alcohol detoxification (B) because the client has elevated vital signs, a sign of alcohol detoxification. Giving lorazepam (Ativan) to address the elevated vital signs due to alcohol withdrawal is a priority. Addressing the risk for injury related to suicidal ideation (A) should come after stabilizing the client's physiological state. Both (C) and (D) can be addressed once immediate safety needs are met, but the priority is managing the alcohol detoxification to prevent potential complications.

5. During discharge planning for a male client with schizophrenia who insists on returning to his apartment despite being informed to move to a boarding home, what is the most important nursing diagnosis?

• A. Ineffective denial related to situational anxiety.
• B. Ineffective coping related to inadequate support.
• C. Social isolation related to difficult interactions.
• D. Self-care deficit related to cognitive impairment.

Correct answer: A

Rationale: The most important nursing diagnosis for discharge planning in this scenario is 'Ineffective denial related to situational anxiety.' The client's insistence on returning to his apartment despite being informed otherwise indicates a form of denial, possibly due to anxiety about the situational change. Focused discharge planning should address this denial and the underlying anxiety to ensure a smooth transition. Choices B, C, and D are not as relevant in this context as the primary issue lies in the client's denial and anxiety regarding the change in living arrangements, rather than coping, social interactions, or self-care deficits.

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