Nursing Elites

1. A female high school teacher who was a child of alcoholic parents seeks counseling at the community health clinic because of depression over a student who was killed by a drunk driver. After several weeks of counseling, which client behavior is the best indicator that the client is coping well with anxiety related to the student’s death?

• A. Signs a safety contract with the nurse agreeing not to hurt herself or others
• B. Confronts her parents about the hurt she felt as a child of alcoholic parents
• C. Becomes the faculty sponsor for Students Against Drunk Driving (SADD)
• D. Describes her feelings about the student’s death in detail

Correct answer: C

Rationale: Becoming the faculty sponsor for Students Against Drunk Driving (SADD) is the best indicator that the client is coping well with anxiety related to the student’s death. This choice demonstrates active involvement in preventing similar tragedies, showing that the client is channeling her emotions into positive action and advocacy. Option A, signing a safety contract, is important for safety but does not directly address coping with the anxiety related to the student's death. Option B, confronting her parents about past hurt, may be beneficial for personal growth but does not directly reflect coping with the current situation. Option D, describing feelings in detail, is a positive step in therapy but does not necessarily indicate coping well with the anxiety related to the student's death.

2. A client with anorexia nervosa has a body mass index (BMI) of 16.5 and has been diagnosed with bradycardia. Which of the following findings should the RN be most concerned about?

• A. Body temperature of 96.8°F.
• B. Heart rate of 52 BPM.
• C. Serum potassium level of 4.1 mEq/L.
• D. Electrocardiogram (ECG) changes.

Correct answer: D

Rationale: In a client with anorexia nervosa and bradycardia, monitoring for ECG changes is crucial as these changes may indicate potentially life-threatening cardiac complications. While other findings like low body temperature, bradycardia, and serum potassium levels are concerning, ECG changes specifically reflect the impact of bradycardia on the heart's electrical activity and should be the priority for the nurse to assess and address.

3. A client who has a history of bipolar disorder is recovering from a manic episode and is now experiencing depressive symptoms. Which action should the nurse take first?

• A. Assess the client for suicidal ideation.
• B. Provide a detailed schedule of daily activities.
• C. Discuss the importance of medication adherence.
• D. Encourage the client to engage in group therapy.

Correct answer: A

Rationale: Assessing for suicidal ideation is the priority when a client with bipolar disorder is transitioning from a manic episode to a depressive phase. Suicidal ideation is a critical concern during depressive episodes, and ensuring the client's safety is the top priority. Providing a detailed schedule of daily activities (Choice B) may be helpful but is not the immediate priority over assessing for suicidal ideation. Discussing the importance of medication adherence (Choice C) and encouraging group therapy (Choice D) are essential components of care but are secondary to ensuring the client's safety in the context of potential suicidal ideation.

4. The RN on the evening shift receives a report that a client is scheduled for electroconvulsive treatment (ECT) in the morning. Which intervention should the RN implement the evening before the scheduled ECT?

• A. Hold all bedtime medications.
• B. Keep the client NPO after midnight.
• C. Implement elopement precautions.
• D. Give the client an enema at bedtime.

Correct answer: B

Rationale: Keeping the client NPO after midnight is the appropriate intervention before ECT to prevent complications during the procedure. Withholding food and fluids reduces the risk of aspiration and helps ensure the safety of the client. Option A (Hold all bedtime medications) is incorrect because medications may need to be given as prescribed unless specified otherwise by the healthcare provider. Option C (Implement elopement precautions) is unrelated to preparing a client for ECT and focuses on preventing a client from leaving the treatment area. Option D (Give the client an enema at bedtime) is unnecessary and not a standard pre-ECT preparation, making it an incorrect choice.

5. A client with schizophrenia explains that she has 20 children and then very seriously points to the nurse and explains that she is one of them. What is the most therapeutic response for the nurse to provide?

• A. Let’s go ask another nurse if this is true.
• B. My name tag shows that I am a nurse here.
• C. I cannot possibly be one of your children.
• D. I know that you don’t have 20 children.

Correct answer: B

Rationale: Option B, 'My name tag shows that I am a nurse here,' is the most appropriate response as it provides clear and factual information to help the client differentiate between reality and delusion. By pointing out a concrete piece of evidence, the nurse can gently guide the client back to reality without directly challenging or contradicting their belief. Option A, 'Let’s go ask another nurse if this is true,' delays addressing the issue and doesn't provide immediate clarification. Option C, 'I cannot possibly be one of your children,' directly contradicts the client's statement and may increase distress. Option D, 'I know that you don’t have 20 children,' does not address the client's belief and can be perceived as dismissive.

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