Nursing Elites

1. A client with panic disorder is experiencing a panic attack. What is the nurse's priority intervention?

• A. Encourage the client to breathe slowly and deeply.
• B. Ask the client to describe the sensations they are experiencing.
• C. Encourage the client to focus on a calming image.
• D. Administer a PRN dose of lorazepam (Ativan).

Correct answer: A

Rationale: The correct answer is A. Encouraging slow, deep breathing is the priority intervention during a panic attack as it can help reduce the physiological symptoms and assist the client in regaining control. This technique can help decrease hyperventilation and promote relaxation. Choice B, asking the client to describe sensations, may be beneficial after the panic attack has subsided to gain insight into triggers or manifestations. Choice C, encouraging the client to focus on a calming image, can be helpful in managing anxiety but may not be as effective during the acute phase of a panic attack. Choice D, administering a PRN dose of lorazepam (Ativan), should only be considered if the client does not respond to initial non-pharmacological interventions or if the symptoms are severe and unmanageable.

2. A middle-aged adult with major depressive disorder suffers from psychomotor retardation, hypersomnia, and low motivation. Which intervention is likely to be most effective in returning this client to a normal level of functioning?

• A. Provide education on methods to enhance sleep.
• B. Teach the client to develop a plan for daily structured activities.
• C. Suggest that the client develop a list of pleasurable activities.
• D. Encourage the client to exercise.

Correct answer: B

Rationale: Teaching the client to develop a plan for daily structured activities is the most effective intervention in this case. Creating a routine can help improve motivation and provide a sense of accomplishment, aiding in the recovery process. Option A, providing education on methods to enhance sleep, may address hypersomnia but does not directly target psychomotor retardation and low motivation. Option C, suggesting the client develop a list of pleasurable activities, may not address the need for structure and routine. Option D, encouraging the client to exercise, is beneficial but may not be as effective as creating a structured daily plan to address the client's specific symptoms.

3. An elderly female client with advanced dementia is admitted to the hospital with a fractured hip. The client repeatedly tells the staff, 'Take me home. I want my Mommy.' Which response is best for the nurse to provide?

• A. Orient the client to the time, place, and person.
• B. Tell the client that the nurse is there and will help her.
• C. Remind the client that her mother is no longer living.
• D. Explain the seriousness of her injury and need for hospitalization.

Correct answer: B

Rationale: Those with dementia often refer to home or parents when seeking security and comfort. The nurse should use the techniques of 'offering self' and 'talking to the feelings' to provide reassurance (B). Clients with advanced dementia have permanent physiological changes in the brain (plaques and tangles) that prevent them from comprehending and retaining new information, so choices A, C, and D are likely to be of little use to this client and do not address the emotional needs expressed by the client. Option B acknowledges the client's feelings, offers support, and provides reassurance, which can help comfort the client during this distressing time.

4. The nurse is caring for a client who received the first-time electroconvulsive therapy (ECT) a half hour ago. Which action should the nurse implement first?

• A. Offer oral fluids.
• B. Monitor vital signs.
• C. Evaluate ECT effectiveness.
• D. Encourage group participation.

Correct answer: B

Rationale: After a client receives electroconvulsive therapy (ECT), the nurse's priority should be to monitor vital signs. This is important to ensure the client's physical stability and detect any immediate complications post-procedure. Offering oral fluids, evaluating ECT effectiveness, and encouraging group participation are all important aspects of care but monitoring vital signs takes precedence in the immediate post-ECT period.

5. A client with depression is started on a selective serotonin reuptake inhibitor (SSRI). What should the LPN/LVN include in the teaching plan?

• A. Take the medication with food to avoid nausea.
• B. You may start feeling better within 1 to 2 weeks.
• C. The medication may take 4 to 6 weeks to become fully effective.
• D. You may experience side effects such as dry mouth or dizziness.

Correct answer: C

Rationale: Teaching the client that the medication may take 4 to 6 weeks to become fully effective is crucial as it helps set realistic expectations. While choice A is important to reduce nausea, it is not the most critical information to provide initially. Choice B is incorrect as improvement usually occurs after several weeks of treatment, not within 1 to 2 weeks. Choice D is also relevant, but informing about the full effectiveness of the medication is more important for long-term adherence.

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