Nursing Elites

1. A homeless person who is in the manic phase of bipolar disorder is admitted to the mental health unit. Which laboratory finding obtained on admission is most important for the nurse to report to the healthcare provider?

• A. Decreased thyroid stimulating hormone level
• B. Elevated liver function profile
• C. Increased white blood cell count
• D. Decreased hematocrit and hemoglobin levels

Correct answer: A

Rationale: The correct answer is A: Decreased thyroid stimulating hormone level. Hyperthyroidism causes an increased level of serum thyroid hormones (T3 and T4), which inhibit the release of TSH. In this case, a decreased TSH level can indicate hyperthyroidism, which can present with manic behavior. Elevated liver function profile (B) is not directly related to the manic phase of bipolar disorder. Increased white blood cell count (C) typically indicates an infection or inflammation, not directly related to the manic phase. Decreased hematocrit and hemoglobin levels (D) may suggest anemia but are not as crucial in the context of a manic phase of bipolar disorder.

2. A female client refuses to take an oral hypoglycemic agent because she believes that the drug is being administered as part of an elaborate plan by the Mafia to harm her. Which nursing intervention is most important to include in this client's plan of care?

• A. Reassure the client that no one will harm her while she is in the hospital.
• B. Ask the healthcare provider to give the client the medication.
• C. Explain the importance of taking the diabetic medication.
• D. Reassess the client's mental status for thought processes and content.

Correct answer: D

Rationale: Reassessing the client's mental status is the most important intervention as it is crucial to address the client's delusional thinking. By assessing the client's thought processes and content, the nurse can gain insight into the client's beliefs and tailor interventions accordingly. Reassuring the client that no harm will come to her, asking the healthcare provider to give the medication, or simply explaining the importance of taking the medication may not effectively address the underlying issue of delusional beliefs.

3. A teenaged male client is admitted to the postoperative unit following open reduction of a fractured femur which occurred when he fell down the stairs at a party. The nurse notices needle marks on the client's arms and plans to observe for narcotic withdrawal. Early signs of narcotic withdrawal include which assessment findings?

• A. Vomiting, seizures, and loss of consciousness.
• B. Depression, fatigue, and dizziness.
• C. Hypotension, shallow respirations, and dilated pupils.
• D. Agitation, sweating, and abdominal cramps.

Correct answer: D

Rationale: Agitation, sweating, and abdominal cramps are early signs of narcotic withdrawal. Vomiting, seizures, and loss of consciousness (Option A) are more indicative of severe withdrawal or overdose symptoms. Depression, fatigue, and dizziness (Option B) are not typically early signs of narcotic withdrawal. Hypotension, shallow respirations, and dilated pupils (Option C) are more associated with opioid overdose rather than withdrawal. Monitoring for agitation, sweating, and abdominal cramps is crucial for managing narcotic withdrawal symptoms effectively.

4. Over a period of several weeks, one male participant of a socialization group at a community day care center for the elderly monopolizes most of the group's time and interrupts others when they are talking. What is the best action for the nurse to take in this situation?

• A. Talk to the participant outside the group about his behavior during group meetings.
• B. Remind the participant to allow others in the group a chance to talk.
• C. Allow the group to handle the problem.
• D. Ask the participant to join another group.

Correct answer: C

Rationale: Allowing the group to handle the situation is the best action as it promotes group dynamics and empowerment, especially since the group is in the working phase. Talking to the participant individually (A) might be seen as manipulative. Reminding the participant (B) can come across as dictatorial and may not address the underlying issue. Asking the participant to join another group (D) does not address the problem at hand and avoids the opportunity for growth and conflict resolution within the current group.

5. A client with schizophrenia is experiencing auditory hallucinations. What is the most appropriate nursing intervention?

• A. Encourage the client to focus on reality-based activities.
• B. Tell the client that the voices are not real.
• C. Ask the client to describe the voices he hears.
• D. Encourage the client to interact with others who are not experiencing hallucinations.

Correct answer: A

Rationale: The most appropriate nursing intervention for a client with schizophrenia experiencing auditory hallucinations is to encourage the client to focus on reality-based activities. This intervention helps redirect their attention away from hallucinations, promoting engagement with the environment. Choice B is incorrect as telling the client that the voices are not real may invalidate their experiences and worsen the therapeutic relationship. Choice C may increase the client's distress by focusing on the hallucinations. Choice D might not be helpful as interacting with others who are not experiencing hallucinations may not address the client's current needs.

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