Nursing Elites

1. A client with schizophrenia is being discharged home after an extended stay in a psychiatric hospital. Which statement by the client indicates that further teaching about medication management is needed?

• A. “I will take my medication only when I feel like it.”
• B. “I need to follow up with my psychiatrist regularly.”
• C. “I will notify my healthcare provider if I experience side effects.”
• D. “I should avoid alcohol while on my medication.”

Correct answer: A

Rationale: The correct answer is A. This statement indicates a lack of understanding about medication management for schizophrenia. Medications for schizophrenia should be taken consistently as prescribed for optimal effectiveness, regardless of how the client feels. Choice B is a correct statement as regular follow-up with a psychiatrist is important for monitoring progress and adjusting treatment. Choice C demonstrates good awareness of potential side effects and the need for communication with healthcare providers. Choice D reflects appropriate knowledge as alcohol can interact with medications and may reduce their effectiveness.

2. After receiving treatment for anorexia, a student asks the school nurse for permission to work in the school cafeteria as part of the school’s work-study program. What action should the nurse take?

• A. Recommend assignment to the receptionist's office.
• B. Suggest that the student work in the athletic department.
• C. Refer the student to a psychiatrist for further discussion.
• D. Determine the parents' opinion of the work assignment.

Correct answer: A

Rationale: Clients with anorexia are often fixated on food and exercise, which can exacerbate their condition. By recommending assignment to the receptionist's office, the nurse provides an environment that minimizes exposure to food-related triggers. Working in the cafeteria may intensify the student's preoccupation with food, making it an unsuitable choice. Referring the student to a psychiatrist without exploring less triggering work options first may not be necessary. Determining the parents' opinion is important, but in this context, the focus should be on selecting a work environment that supports the student's recovery.

3. The nurse accepts a transfer to the mental health unit and understands that the client is distractible and is exhibiting a decreased ability to concentrate. The nurse has only 15 minutes to talk with the client. To develop a treatment plan for this client, which assessment is most important for the nurse to obtain?

• A. Motivation for treatment
• B. History of substance use
• C. Medication compliance
• D. Mental status examination

Correct answer: D

Rationale: A mental status examination is the most important assessment for the nurse to obtain in this scenario. It provides a comprehensive view of the client's current cognitive functioning, including their level of alertness, orientation, memory, attention, and thought process. Understanding the client's mental status is crucial for developing an appropriate treatment plan. The other options, such as motivation for treatment, history of substance use, and medication compliance, are important aspects to consider but may not directly address the client's current cognitive state and immediate treatment needs as effectively as a mental status examination.

4. The mental health team is determining treatment options for a male patient experiencing psychotic symptoms. Which question(s) should the team answer to determine whether a community outpatient or inpatient setting is most appropriate? Select all that apply.

• A. Is the patient expressing suicidal thoughts?
• B. Does the patient have experiences with either community or inpatient mental healthcare facilities?
• C. Does the patient require a therapeutic environment to support the management of psychotic symptoms?
• D. Is the patient experiencing delusions or hallucinations?

Correct answer: B

Rationale: To determine whether a community outpatient or inpatient setting is most appropriate for a patient experiencing psychotic symptoms, it is crucial to consider if the patient has had experiences with either community or inpatient mental healthcare facilities. This helps assess the familiarity and comfort level of the patient in those settings, aiding in decision-making regarding the level of care needed. Choice A, addressing suicidal thoughts, is important for risk assessment and safety planning but does not directly help in determining the setting appropriateness between community outpatient or inpatient care. Choice C, about the need for a therapeutic environment, is significant but does not specifically assist in deciding between outpatient or inpatient care. Choice D, related to delusions or hallucinations, is relevant in assessing the symptomatology but does not directly guide the choice between community outpatient or inpatient care.

5. A male client comes to the emergency center with an erection that will not resolve. The client reports that he is taking trazodone (Desyrel) for insomnia. Which information is most important for the nurse to ask this client?

• A. Have you taken any medication for erectile dysfunction?
• B. Are you experiencing any other sexual dysfunctions or problems?
• C. When was the last time you consumed alcohol?
• D. Do you have a history of angina or high blood pressure?

Correct answer: B

Rationale: In this scenario, the most important question for the nurse to ask the client is whether he is experiencing any other sexual dysfunctions or problems. This inquiry is crucial as it can help in determining if the persistent erection is a side effect of trazodone. Asking about medication for erectile dysfunction (Choice A) may not provide relevant information in this case, as the focus is on the potential side effects of trazodone. Inquiring about the last time the client consumed alcohol (Choice C) is not directly related to the situation at hand. Questioning about a history of angina or high blood pressure (Choice D) is important for overall assessment but is not as directly relevant to the immediate concern of the persistent erection potentially caused by trazodone.

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