Nursing Elites

1. A female client with bulimia nervosa is admitted to the hospital. Which intervention should the nurse include in the plan of care?

• A. Allow the client to eat meals alone to reduce stress.
• B. Observe the client for 30 minutes after meals.
• C. Provide the client with a high-calorie diet.
• D. Encourage the client to weigh herself daily.

Correct answer: B

Rationale: The correct intervention for a client with bulimia nervosa is to observe the client for 30 minutes after meals. This helps prevent purging behaviors, such as vomiting or using laxatives, which are common in bulimia nervosa. Choice A is incorrect because eating meals alone may enable the client to engage in purging behaviors without being observed. Choice C is incorrect as a high-calorie diet may exacerbate the client's concerns about weight gain. Choice D is incorrect because encouraging daily weigh-ins can reinforce obsessive thoughts about weight and body image.

2. A client is being successfully treated with clozapine (Clozaril). Which of the following statements by the client reflects a need for further teaching about managing the drug's adverse effects?

• A. If I eat too many fruits, I'll get constipated.
• B. I need to take the medicine with food to avoid nausea.
• C. I have to get up slowly so I don't get dizzy.
• D. Sometimes I have to push myself because I'm sleepy.

Correct answer: A

Rationale: Choice A reflects a need for further teaching as the client mistakenly believes that eating too many fruits causes constipation, showing a misunderstanding about dietary fiber's role in preventing constipation. Choices B, C, and D demonstrate accurate understanding of managing clozapine's adverse effects, such as taking it with food to avoid nausea, getting up slowly to prevent dizziness, and pushing oneself when feeling sleepy.

3. In the described scenario, a manic client threatens a nurse with physical violence after being told they cannot have a stripper perform. What is the most appropriate action for the LPN/LVN to take?

• A. Orient the client to time, person, and place
• B. Tell the client that the behavior is inappropriate
• C. Escort the manic client to her room, with assistance
• D. Tell the client that smoking privileges are revoked for 24 hours

Correct answer: C

Rationale: In this situation, where the manic client becomes verbally abusive and threatens physical violence, the most appropriate action for the LPN/LVN is to escort the client to her room with assistance. This action helps ensure the safety of both the client and the nurse, while also providing a controlled environment that can help de-escalate the situation. Choices A and B do not address the immediate safety concerns presented by the client's behavior. Choice D, revoking smoking privileges, is not directly related to the client's current behavior and does not address the threat of violence.

4. An 86-year-old female client with Alzheimer's disease is wandering the busy halls of the extended care facility and asks the nurse, 'Where should I stand for the parade?' Which response is best for the nurse to provide?

• A. "You can stand wherever you'd like as long as you stay safe from those in the parade."
• B. "You seem confused because of all the activity in the hall. There is no parade."
• C. "Let's go back to the activity room and see what is going on in there."
• D. "Remember, this is a nursing home, and I am here to help you."

Correct answer: C

Rationale: (C) is the best response as it redirects the client to a safer, familiar place. (A) is dismissive and does not address the client's needs directly. (B) labels the behavior, which may increase the client's anxiety. (D) is scolding and may not be helpful in the situation.

5. A female client is brought to the emergency department after police officers found her disoriented, disorganized, and confused. The RN also determines that the client is homeless and is exhibiting suspiciousness. The client's plan of care should include what priority problem?

• A. Acute confusion.
• B. Ineffective community coping.
• C. Disturbed sensory perception.
• D. Self-care deficit.

Correct answer: A

Rationale: Acute confusion is the priority problem as it directly affects the client's ability to process information and make safe decisions. In this scenario, the client's disorientation, disorganization, and confusion indicate an immediate cognitive issue that requires attention to ensure her safety and stability. Choices B, C, and D are not the priority problems in this case. Ineffective community coping, disturbed sensory perception, and self-care deficit, while important, are secondary to the client's acute confusion, which poses an immediate risk to her well-being.

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