Nursing Elites

1. A male client tells the RN that he does not want to take the atypical antipsychotic drug, olanzapine (Zyprexa), because of the side effects he experienced when he took it previously. Which statement is best for the RN to provide?

• A. The medication has side effects, but they are manageable.
• B. If you refuse the medication, you will be restrained.
• C. The doctor will try another medication if this one is not effective.
• D. It is important to take the medication as prescribed for it to be effective.

Correct answer: A

Rationale: It is essential for the nurse to address the client's concerns about the side effects of the medication. By acknowledging the side effects and reassuring the client that they are manageable, the nurse empowers the client to make an informed decision about their treatment. This approach fosters trust between the client and the healthcare provider, promotes open communication, and supports treatment adherence. Choices B and D are not appropriate as they do not address the client's specific concern about the side effects or offer constructive support. Choice C is premature as switching medications should be considered after exploring ways to manage the side effects of the current medication.

2. The client is preparing to discontinue the use of a sedative-hypnotic medication. Which instruction should the nurse include?

• A. “You may experience withdrawal symptoms; these are usually mild.”
• B. “The medication will need to be gradually tapered off.”
• C. “You should increase your caffeine intake to stay alert.”
• D. “There should be no change in your sleep patterns during discontinuation.”

Correct answer: B

Rationale: When discontinuing sedative-hypnotic medications, it is crucial to gradually taper them off to prevent withdrawal symptoms. Choice A is incorrect because withdrawal symptoms can be severe, not always mild. Choice C is incorrect as increasing caffeine intake can exacerbate sleep disturbances. Choice D is incorrect because changes in sleep patterns are expected during discontinuation of sedative-hypnotic medications.

3. A client is being treated for generalized anxiety disorder (GAD) and is prescribed an SSRI. Which side effect should the nurse educate the client about?

• A. Weight loss
• B. Increased appetite
• C. Insomnia
• D. Dry mouth

Correct answer: C

Rationale: The correct answer is C: Insomnia. Insomnia is a common side effect of SSRIs, including those used to treat generalized anxiety disorder (GAD). Educating the client about potential side effects like insomnia is crucial for managing expectations and promoting treatment adherence. Weight loss (choice A) is less common with SSRIs and might not be a primary concern for a client with GAD. Increased appetite (choice B) is also less likely with SSRIs. Dry mouth (choice D) is a side effect more commonly associated with other classes of medications, such as anticholinergics, rather than SSRIs.

4. An adolescent with anorexia nervosa is participating in a cognitive-behavioral therapy (CBT) program. Which behavior indicates that the therapy is effective?

• A. Client adheres to a meal plan and gains weight.
• B. Client discusses the impact of the disorder on family.
• C. Client expresses a desire to change behavior.
• D. Client reduces the frequency of binge eating.

Correct answer: A

Rationale: In treating anorexia nervosa with cognitive-behavioral therapy (CBT), the primary goals are to normalize eating behaviors and achieve weight restoration. Therefore, adherence to a meal plan and weight gain are crucial indicators of treatment effectiveness. While discussing the impact of the disorder on the family (Choice B) can be beneficial for therapy, it may not directly indicate the effectiveness of CBT in treating anorexia nervosa. Expressing a desire to change behavior (Choice C) is a positive step, but actual behavioral changes such as adhering to a meal plan are more indicative of progress. Reducing the frequency of binge eating (Choice D) is more relevant for other eating disorders like bulimia nervosa, not anorexia nervosa.

5. What principle about patient-nurse communication should guide a nurse's fear of 'saying the wrong thing' to a patient?

• A. Patients tend to appreciate a well-meaning person who conveys genuine acceptance, respect, and concern for their situation.
• B. The patient is more interested in talking to you than listening to what you have to say and is not likely to be offended.
• C. Considering the patient's history, there is little chance that the comment will do any actual harm.
• D. Most people with a mental illness have by necessity developed a high tolerance for forgiveness.

Correct answer: A

Rationale: The correct principle guiding nurse-patient communication is that patients value genuine acceptance, respect, and concern. Choice A is the correct answer because showing genuine care and concern for the patient's situation fosters a positive and therapeutic relationship. Choice B is incorrect as effective communication involves active listening and responding appropriately, not assuming the patient is only interested in talking. Choice C is incorrect because a patient's history does not guarantee immunity to harm from inappropriate comments. Choice D is incorrect as it generalizes individuals with mental illness and forgiveness, which is not directly related to communication fears.

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