Nursing Elites

1. After a client with major depressive disorder undergoes electroconvulsive therapy (ECT), which of the following is a priority assessment for the nurse?

• A. Monitoring for signs of infection
• B. Monitoring for signs of respiratory distress
• C. Monitoring for signs of hypotension
• D. Monitoring for signs of bleeding

Correct answer: B

Rationale: The priority assessment for the nurse after a client undergoes electroconvulsive therapy (ECT) is monitoring for signs of respiratory distress. This is crucial due to the potential risk of complications from anesthesia, such as airway compromise or respiratory depression. Prompt identification and intervention in case of respiratory distress are essential to ensure the client's safety and well-being. Monitoring for signs of infection (Choice A) is important but not the priority immediately post-ECT. Hypotension (Choice C) and bleeding (Choice D) are also potential concerns but assessing respiratory distress takes precedence due to the immediate risk it poses to the client's well-being.

2. A client with obsessive-compulsive disorder (OCD) spends several hours each day washing her hands. Which intervention should the nurse implement?

• A. Encourage the client to wash her hands less frequently.
• B. Set a time limit for hand washing.
• C. Teach the client relaxation techniques.
• D. Discourage the client from washing her hands.

Correct answer: B

Rationale: Setting a time limit for hand washing is an appropriate intervention for a client with OCD who spends excessive time on this compulsive behavior. By setting a time limit, the nurse can help the client gradually reduce the compulsive behavior, promoting a more manageable approach to hand washing without completely discouraging it. Encouraging the client to wash her hands less frequently (Choice A) may not address the root of the issue and could lead to increased anxiety. Teaching relaxation techniques (Choice C) may be helpful for overall anxiety management but may not directly address the excessive hand washing behavior. Discouraging the client from washing her hands (Choice D) may increase anxiety and resistance, making it a less effective intervention.

3. A 33-year-old female diagnosed with bipolar I disorder has been functioning well on lithium for 11 months. At her most recent checkup, the psychiatric nurse practitioner states, 'You are ready to enter the maintenance therapy stage, so at this time I am going to adjust your dosage by prescribing:'

• A. A higher dosage
• B. Once-weekly dosing
• C. A lower dosage
• D. A different drug

Correct answer: C

Rationale: During the maintenance therapy stage for bipolar I disorder, it is common to lower the dosage of lithium to prevent side effects while still maintaining stability. Lowering the dosage helps to find the lowest effective dose that can still manage symptoms effectively with minimal side effects.

4. Which intervention is particularly well chosen for addressing a population at high risk for developing schizophrenia?

• A. Screening a group of males aged 15 to 25 for early symptoms.
• B. Forming a support group for females aged 25 to 35 with substance use issues.
• C. Providing coping skills information to a group aged 45 to 55.
• D. Educating parents of developmentally delayed 5- to 6-year-olds on early intervention importance.

Correct answer: A

Rationale: Screening males aged 15 to 25 for early symptoms of schizophrenia is a well-chosen intervention as this age group is at a higher risk for developing the condition. Early identification can lead to timely treatment and better outcomes, making this intervention particularly effective in addressing the population at risk for schizophrenia.

5. A client is experiencing a moderate level of anxiety. Which is an example of an appropriate nursing intervention?

• A. Allow the client to pace in a safe environment.
• B. Encourage the client to discuss feelings.
• C. Help the client identify the cause of anxiety.
• D. Provide a distraction for the client.

Correct answer: A

Rationale: Allowing the client to pace in a safe environment is an appropriate nursing intervention for managing moderate anxiety levels. Allowing pacing provides the client with a physical outlet for their anxiety and can help them release nervous energy without increasing distress. It promotes movement and can aid in reducing feelings of restlessness or agitation. Encouraging the client to discuss feelings (Choice B) is more suitable for addressing emotional aspects of anxiety rather than providing an immediate physical outlet. Helping the client identify the cause of anxiety (Choice C) may be more appropriate for long-term management but may not address the immediate need for physical release. Providing a distraction (Choice D) may not directly address the physical needs associated with moderate anxiety levels.

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