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. A male client is admitted to the psychiatric unit for recurrent negative symptoms of chronic schizophrenia and medication adjustment of risperidone (Risperdal). When the client walks to the nurse’s station in a laterally contracted position, he states that something has made his body contort into a monster. What action should the nurse take?

• A. Medicate the client with the prescribed antipsychotic thioridazine (Mellaril).
• B. Offer the client a prescribed physical therapy hot pack for muscle spasms.
• C. Administer the prescribed anticholinergic benztropine (Cogentin) for dystonia.
• D. Direct the client to occupational therapy to distract him from somatic complaints.

Correct answer: C

Rationale: The client is experiencing a dystonic reaction due to dopamine depletion, which is a known side effect of Risperidone. Dystonia presents as abnormal muscle contractions and postures. The immediate management for this side effect is the administration of an anticholinergic medication like Benztropine (Cogentin). Choice A is incorrect as thioridazine is not the recommended medication for dystonic reactions. Choice B is incorrect as a hot pack would not effectively address the underlying cause of the dystonic reaction. Choice D is incorrect as occupational therapy is not the appropriate intervention for managing acute dystonia.

3. A client who is admitted with a closed head injury after a fall has a blood alcohol level (BAL) of 0.28 (28%) and is difficult to arouse. Which intervention during the first 6 hours following admission should the nurse identify as the priority?

• A. Place in a side-lying position with head of bed elevated.
• B. Administer disulfiram (Antabuse) immediately
• C. Give lorazepam (Ativan) PRN for signs of withdrawal.
• D. Provide thiamine and folate supplements as prescribed.

Correct answer: A

Rationale: Maintain the patient's airway is the priority for a client who is intoxicated and obtunded.

4. Which factors tend to increase the difficulty of diagnosing young children who demonstrate behaviors associated with mental illness? Select all that apply.

• A. Limited language skills
• B. Level of cognitive development
• C. Level of emotional development
• D. Parental denial that a problem exists

Correct answer: B

Rationale: The correct answer is B: Level of cognitive development. The level of cognitive development is a crucial factor that can complicate the diagnosis of mental illness in young children. Young children may not have fully developed cognitive abilities to express their symptoms or understand diagnostic procedures, making it challenging for healthcare providers to assess their mental health accurately. Limited language skills (choice A) can hinder communication but are not as significant as cognitive development in diagnosing mental illness. Emotional development (choice C) is important but may not be as directly linked to the diagnostic challenges as cognitive development. Parental denial (choice D), although a potential barrier, is not a factor inherent to the child's characteristics affecting the diagnostic process.

5. While sitting in the day room of the mental health unit, a male adolescent avoids eye contact, looks at the floor, and talks softly when interacting verbally with the RN. The two trade places, and the RN demonstrates the client's behaviors. What is the main goal of this therapeutic technique?

• A. Initiate a non-threatening conversation with the client.
• B. Dialog about the ineffectiveness of his interactions.
• C. Allow the client to identify the way he interacts.
• D. Discuss the client's feelings when he responds.

Correct answer: C

Rationale: The main goal of the therapeutic technique described is to allow the client to identify the way he interacts. This technique helps promote self-awareness in the client by mirroring his behavior back to him, which can lead to insights about his own communication style. Option A is incorrect as the goal is not just to initiate conversation but to facilitate self-reflection. Option B is incorrect because the focus is not on discussing the ineffectiveness of the interactions but on self-awareness. Option D is incorrect as the primary aim is not to discuss the client's feelings but to help him recognize his interaction patterns.

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