Nursing Elites

1. A LVN/LPN is caring for a client with anorexia nervosa. The nurse is monitoring the behavior of the client and understands that a client with anorexia nervosa manages anxiety by:

• A. Engaging in immoral acts
• B. Always reinforcing self-approval
• C. Observing rigid rules and regulations
• D. Having the need always to make the right decision

Correct answer: C

Rationale: Clients with anorexia nervosa often manage anxiety by adhering strictly to rules and regulations as a way to maintain control. Choice A is incorrect because engaging in immoral acts is not a common coping mechanism for clients with anorexia nervosa. Choice B is incorrect as self-approval is not typically the primary way clients with anorexia nervosa manage anxiety. Choice D is incorrect because while clients with anorexia nervosa may have a need to make the right decision, it is not the primary way they manage their anxiety.

2. A client is admitted to the mental health unit and sits in the corner of the day room. When the nurse begins the admission assessment interview, the client is guarded, suspicious, and resists talking. What action should the nurse implement?

• A. Attempt to ask the client simple questions.
• B. Postpone the client interview until the next day.
• C. Ask another nurse to talk with the client.
• D. Document the client's paranoid behavior.

Correct answer: A

Rationale: When a client is guarded, suspicious, and resistant to talking, it is important for the nurse to attempt to ask the client simple questions. Simple questions can help build rapport, establish trust, and create a non-threatening environment. This approach may ease the client into more detailed discussions while reducing feelings of suspicion. Postponing the interview may increase the client's anxiety and distrust, while asking another nurse to talk with the client may disrupt continuity of care and the establishment of a therapeutic relationship. Documenting the client's behavior is important for the client's medical record, but it should not be the first action taken in this situation.

3. The LPN/LVN is assessing a client's intelligence. Which factor should the nurse remember during this part of the mental status exam?

• A. Acute psychiatric illnesses impair intelligence.
• B. Intelligence is influenced by social and cultural factors.
• C. Poor concentration skills suggest limited intelligence.
• D. The inability to think abstractly indicates limited intelligence.

Correct answer: B

Rationale: The correct answer is B because intelligence is influenced by social and cultural factors. Social and cultural beliefs can impact how intelligence is perceived and expressed. Choice A is incorrect because acute psychiatric illnesses can affect cognitive functioning but not necessarily intelligence. Choice C is incorrect because poor concentration skills do not always correlate with limited intelligence. Choice D is incorrect because the inability to think abstractly is just one aspect of intelligence and does not solely indicate limited intelligence.

4. What is the best initial action for the nurse to take with a manic depressive male client who becomes loud and verbally aggressive towards a nurse?

• A. Have the staff escort the client to his room.
• B. Tell the client that his behavior will be recorded in his record.
• C. Redirect the client by asking him to engage in a game with peers.
• D. Review the medication record for an antipsychotic drug.

Correct answer: C

Rationale: In dealing with a manic depressive client who is being verbally aggressive, the best initial action for the nurse is to redirect the client by engaging him in a more constructive activity, such as playing card games with peers. This approach can help de-escalate the situation, shift the client's focus positively, and provide a distraction from the current behavior. Having the staff escort the client to his room may escalate the situation further. Threatening to record the behavior in his record is not likely to be effective in managing the immediate situation. Reviewing the medication record for an antipsychotic drug is important but would not be the best initial action in this scenario when the client is being verbally aggressive.

5. The RN is preparing to administer a prescribed dose of haloperidol (Haldol) to a client with schizophrenia. The client begins to exhibit muscle rigidity, fever, and altered mental status. What action should the RN take first?

• A. Administer the haloperidol as prescribed.
• B. Monitor the client's vital signs closely.
• C. Hold the medication and notify the healthcare provider.
• D. Give the client an antipyretic for the fever.

Correct answer: C

Rationale: Muscle rigidity, fever, and altered mental status are symptoms of neuroleptic malignant syndrome (NMS), a potentially life-threatening reaction to antipsychotic medications. The RN should hold the medication and notify the healthcare provider immediately. Option A is incorrect because administering more of the medication can worsen the symptoms. Option B is not the first priority when the client is experiencing symptoms of NMS. Option D is incorrect as addressing the fever alone does not address the underlying issue of NMS caused by haloperidol.

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