Nursing Elites

1. A male client is brought to the emergency department by a police officer, who reports the client was disturbing the peace by running naked in the street, striking out at others, and smashing car windows. Which behaviors should the client demonstrate to determine if he should be evaluated for involuntary commitment?

• A. Threats to kill his friend.
• B. Disruptive behaviors in a community setting.
• C. Hears voices telling him to kill himself.
• D. Reports he has not needed a bath in 4 months.

Correct answer: D

Rationale: The client's dangerous and disruptive behaviors, along with auditory hallucinations of self-harm, suggest a need for involuntary commitment for his safety and that of others. Involuntary commitment may be warranted based on the client's poor hygiene and self-neglect, as it indicates an inability to care for himself, which can pose a risk to his well-being.

2. The nurse is leading a 'current events group' with chronic psychiatric clients. One group member states, 'Clara Barton was my nurse during my last hospitalization. She was a very mean nurse and wasn't nice to me.' Which response would be best for the nurse to make?

• A. 'Clara Barton was not your nurse.'
• B. 'What did she do to you that was so mean?'
• C. 'I didn't know that Clara Barton was a nurse.'
• D. 'Clara Barton started the American Red Cross.'

Correct answer: D

Rationale: (D) presents the reality of the situation in relation to American culture. The fact that Clara Barton was a nurse during the Civil War should be addressed on an individual basis. Since this is group therapy, the nurse would be illustrating the concept of universality. (A) is likely to promote defensiveness. (B and C) would support the delusion. Therefore, the most appropriate response is (D) as it provides factual information that can redirect the conversation in a constructive manner.

3. A client with obsessive-compulsive disorder (OCD) spends several hours a day arranging and rearranging items in their room. What is the most therapeutic nursing intervention?

• A. Distract the client with another activity.
• B. Allow the client to continue the behavior.
• C. Set a time limit for the behavior.
• D. Encourage the client to verbalize their feelings.

Correct answer: D

Rationale: Encouraging the client to verbalize their feelings is the most therapeutic intervention for a client with OCD spending excessive time on compulsive behaviors. By expressing their feelings, the client can explore the underlying anxiety that drives the compulsion. This intervention also provides an opportunity for the nurse to offer support and help the client develop coping strategies.\n Choice A, distracting the client with another activity, may provide temporary relief but does not address the root cause of the behavior.\n Choice B, allowing the client to continue the behavior, does not promote therapeutic progress and may perpetuate the compulsion.\n Choice C, setting a time limit for the behavior, may create additional stress for the client and does not address the underlying emotional issues associated with OCD.

4. A male client is admitted to the psychiatric inpatient unit with a bandaged flesh wound after attempting to shoot himself. He was divorced one year ago, lost his job four months ago, and suffered a breakup of his current relationship last week. What is the most likely source of this client's current feelings of depression?

• A. Feelings of frustration.
• B. A sense of loss.
• C. Poor self-esteem.
• D. A lack of intimate relationships.

Correct answer: B

Rationale: The client's recent life events, including divorce, job loss, and relationship breakup, all contribute to a significant sense of loss, which is likely the source of his current feelings of depression. While feelings of frustration and poor self-esteem could be present, the major life events the client has experienced are more closely associated with a sense of loss. A lack of intimate relationships is not the primary factor contributing to his depression in this scenario.

5. A nurse is assessing a client with dementia who is showing signs of increased confusion and agitation in the late afternoon. What is the most likely explanation for the client's symptoms?

• A. Anxiety
• B. Depression
• C. Sun-downing syndrome
• D. Medication side effects

Correct answer: C

Rationale: The correct answer is C: Sun-downing syndrome. Sun-downing syndrome is a phenomenon commonly seen in individuals with dementia, where they exhibit increased confusion and agitation in the late afternoon or evening. This pattern of behavior is believed to be linked to disruptions in the circadian rhythm and can be triggered by factors such as fatigue, low lighting, or increased shadows during the evening. Choices A and B, anxiety and depression, may be comorbid conditions in individuals with dementia but are not the primary explanation for the symptoms described. While medication side effects (Choice D) should always be considered in a client with dementia, given the time-specific nature of the symptoms, sun-downing syndrome is the most likely explanation in this case.

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