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. 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.

3. When preparing to administer a prescribed medication to a homeless male at a community psychiatric clinic, the client tells the nurse that he usually takes a different dosage. What action should the nurse take?

• A. Tell him to take the medication then verify the dosage at the next healthcare team meeting.
• B. Withhold the medication until the dosage can be confirmed.
• C. Inform him that he may refuse the medication and document whether or not he takes it.
• D. Explain to the client that the dosage has been changed.

Correct answer: B

Rationale: Withholding the medication until the dosage can be confirmed ensures patient safety and accuracy in treatment.

4. The nurse is completing the admission assessment of an underweight adolescent admitted to the psychiatric unit with a diagnosis of depression. Which finding requires notification to the healthcare provider?

• A. Body mass index of 21
• B. Potassium level of 2.9 mEq/dL
• C. WBC count of 10,000/mm3
• D. Blood pressure of 110/70 mmHg

Correct answer: B

Rationale: The correct answer is B. A potassium level of 2.9 mEq/dL is critically low and requires immediate notification to the healthcare provider as it indicates a potential electrolyte imbalance, which can lead to serious cardiac arrhythmias and other complications. Choices A, C, and D are within normal ranges or not indicative of immediate life-threatening issues. A body mass index of 21 may be considered normal for some individuals, a WBC count of 10,000/mm3 is slightly elevated but not an urgent concern, and a blood pressure of 110/70 mmHg is within normal limits for an adolescent.

5. The nurse is using the CAGE questionnaire as a screening tool for a client who is seeking help because his wife said he had a drinking problem. What information should the nurse explore in-depth with the client based on this screening tool?

• A. Cancer screening result and gastritis daily alcohol intake.
• B. Consumption, liver enzyme gastrointestinal complaints, and bleeding.
• C. Efforts to cut down, annoyance with questions, guilt, and drinking as an eye-opener.
• D. Minimizes drinking, frequently misses family events, guilt about drinking, and amount of daily intake.

Correct answer: C

Rationale: The CAGE questionnaire focuses on the client’s self-perception and behaviors related to drinking, such as efforts to cut down and guilt.

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