Nursing Elites

1. When a client with major depressive disorder expresses feelings of worthlessness and hopelessness, what is the nurse's priority intervention?

• A. Encourage the client to engage in recreational activities.
• B. Suggest the client keep a journal of their thoughts and feelings.
• C. Assess the client for suicidal ideation.
• D. Provide the client with positive affirmations.

Correct answer: C

Rationale: The correct answer is to assess the client for suicidal ideation. When a client expresses feelings of worthlessness and hopelessness, it is crucial to evaluate the risk of self-harm. Encouraging recreational activities (choice A) or suggesting journaling (choice B) may be helpful interventions but assessing for suicidal ideation takes precedence due to the immediate risk of harm. Providing positive affirmations (choice D) is not the priority when safety is a concern.

2. During an annual physical by the occupational nurse working in a corporate clinic, a male employee tells the nurse that his high-stress job is causing trouble in his personal life. He further explains that he often gets so angry while driving to and from work that he has considered 'getting even' with other drivers. How should the nurse respond?

• A. Anger is contagious and could result in major confrontation.
• B. Try not to let your anger cause you to act impulsively.
• C. Expressing your anger to a stranger could result in an unsafe situation.
• D. It sounds as if you feel angry for no reason

Correct answer: C

Rationale: The correct responses are C and D. The nurse should acknowledge the employee's feelings of anger and suggest that expressing anger to strangers, like other drivers, could lead to unsafe situations. This response aims to prevent potential confrontations or harm. Choice A is incorrect as it doesn't address the specific situation of expressing anger while driving. Choice B is also incorrect as it is vague and doesn't provide practical advice to manage the anger effectively.

3. During a mental status exam, what factor should the nurse remember when assessing a client's intelligence?

• A. Acute psychiatric illnesses can impair intelligence
• B. Intelligence can be influenced by social and cultural beliefs
• C. Poor concentration skills suggest limited intelligence
• D. The inability to think abstractly indicates limited intelligence

Correct answer: B

Rationale: The correct answer is B. Intelligence is indeed influenced by social and cultural beliefs. It is essential to recognize that intelligence is not solely determined by innate abilities but can also be shaped by various external factors such as cultural background, education, and social environment. Choices A, C, and D are incorrect because acute psychiatric illnesses do not necessarily impair intelligence, poor concentration skills do not always suggest limited intelligence, and the inability to think abstractly alone does not always indicate limited intelligence.

4. A client who is being treated with lithium carbonate for bipolar disorder develops diarrhea, vomiting, and drowsiness. What action should the LPN/LVN take?

• A. Notify the healthcare provider immediately and prepare for administration of an antidote.
• B. Notify the healthcare provider of the symptoms prior to the next administration of the drug.
• C. Record the symptoms as normal side effects and continue administration of the prescribed dosage.
• D. Hold the medication and refuse to administer additional amounts of the drug.

Correct answer: B

Rationale: When a client being treated with lithium carbonate for bipolar disorder develops symptoms like diarrhea, vomiting, and drowsiness, it could indicate lithium toxicity. The appropriate action for the LPN/LVN is to notify the healthcare provider immediately of these symptoms before the next administration of the drug. This prompt communication is crucial to ensure that the healthcare provider can assess the situation, adjust the treatment plan if necessary, and prevent potential complications associated with lithium toxicity. Option A is incorrect because administering an antidote should be based on the healthcare provider's assessment. Option C is incorrect as these symptoms are not normal side effects and could indicate a serious issue. Option D is incorrect because refusing to administer the drug without consulting the healthcare provider could delay necessary interventions.

5. A 45-year-old female client is admitted to the psychiatric unit for evaluation. Her husband states that she has been reluctant to leave home for the last six months. The client has not gone to work for a month and has been terminated from her job. She has not left the house since that time. This client is displaying symptoms of what condition?

• A. Claustrophobia
• B. Acrophobia
• C. Agoraphobia
• D. Post-traumatic stress disorder

Correct answer: C

Rationale: The correct answer is C: Agoraphobia. Agoraphobia is the fear of crowds or being in open places, often leading individuals to avoid situations where they feel trapped, insecure, or out of control. In the case described, the client's reluctance to leave home, avoidance of work, and isolation within the house are indicative of agoraphobia. Claustrophobia (A) is the fear of closed places, while acrophobia (B) is the fear of high places. Post-traumatic stress disorder (D) involves the development of anxiety symptoms following a traumatic event, characterized by terror, fear, and helplessness, and is different from a phobia.

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