Nursing Elites

1. A male client with schizophrenia is admitted to the mental health unit after abruptly stopping his prescription for ziprasidone (Geodon) one month ago. Which question is most important for the nurse to ask the client?

• A. Have you lost interest in activities you used to enjoy?
• B. Has your ability to think or concentrate decreased?
• C. How many consecutive hours do you sleep at night?
• D. Do you hear sounds or voices that others do not hear?

Correct answer: D

Rationale: Inquiring about hallucinations is crucial for assessing the return of psychotic symptoms due to discontinuation of antipsychotic medication. Hearing sounds or voices that others do not hear can indicate the presence of auditory hallucinations, a common symptom in schizophrenia. Choices A, B, and C are important aspects to assess in clients with schizophrenia, but in this scenario, the priority is to determine if the client is experiencing hallucinations, which can be a sign of worsening psychotic symptoms.

2. The RN documents the mental status of a female client who has been hospitalized for several days by court order. The client states, “I don’t need to be here,” and tells the RN that she believes that the TV talks to her. The RN should document these assessment statements in which section of the mental status exam?

• A. Insight and judgment.
• B. Mood and affect.
• C. Remote memory.
• D. Level of concentration.

Correct answer: A

Rationale: The client's statement of not needing to be hospitalized and her belief that the TV talks to her indicate impaired insight and judgment. Insight and judgment evaluate the client's awareness of their condition and ability to make sound decisions. Mood and affect assess emotional state, remote memory evaluates recall of past events, and level of concentration assesses attention and focus. In this scenario, the client's lack of awareness of her need for hospitalization and presence of delusions about the TV speaking to her directly relate to insight and judgment, making choice A the correct option.

3. A male hospital employee is pushed out of the way by a female employee because of an oncoming gurney. The pushed employee becomes very angry and swings at the female employee. Both employees are referred for counseling with the staff psychiatric nurse. Which factor in the pushed employee’s history is most related to the reaction that occurred?

• A. Is worried about losing his job to a woman.
• B. Tortured animals as a child.
• C. Was physically abused by his mother.
• D. Hates to be touched by anyone.

Correct answer: C

Rationale: The correct answer is 'C: Was physically abused by his mother.' The pushed employee's aggressive reaction can be attributed to his history of physical abuse. Research suggests that individuals who have experienced physical abuse may exhibit heightened aggressive responses due to trauma and learned behavior. Choices A, B, and D are incorrect: A is a stereotype-based assumption that does not have a direct correlation with the aggressive behavior observed; B, torturing animals, is concerning behavior but not directly linked to the aggressive response in this scenario; D, hating to be touched, is not the most relevant factor considering the situation described.

4. A female client engages in repeated checks of door and window locks, behavior that prevents her from arriving on time and interferes with her ability to function effectively. What action should the nurse take?

• A. Discuss why the client checks the locks frequently
• B. Ask the client why she checks the locks
• C. Plan a daily list of activities to be carried out
• D. Determine the type and size of the locks

Correct answer: B

Rationale: The correct action for the nurse to take is to ask the client why she checks the locks. By doing so, the nurse can help the client gain insight into the underlying anxiety that drives this behavior and assist her in developing new adaptive coping strategies. Choice A is not as effective as directly asking the client about her behavior. Choice C focuses on planning activities but does not address the root cause of the client's behavior. Choice D is irrelevant to addressing the client's repeated checking behavior.

5. A male client with bipolar disorder who began taking lithium carbonate five days ago is complaining of excessive thirst, and the RN finds him attempting to drink water from the bathroom sink faucet. Which intervention should the RN implement?

• A. Report the client’s serum lithium level to the healthcare provider (HCP).
• B. Encourage the client to suck on hard candy to relieve the symptoms.
• C. No action is needed since polydipsia is a common side effect.
• D. Tell the client that drinking from the faucet is not allowed.

Correct answer: B

Rationale: Encouraging the client to suck on hard candy is the appropriate intervention in this situation. Excessive thirst is a common side effect of lithium therapy. Sucking on hard candy can help alleviate the symptom without posing any harm. Reporting the client's serum lithium level to the healthcare provider (Choice A) is not necessary at this point as the symptom of excessive thirst is a known side effect and does not indicate toxicity. No action is needed (Choice C) is incorrect because addressing the client's distress is essential. Telling the client that drinking from the faucet is not allowed (Choice D) does not address the underlying issue of excessive thirst and may cause further distress to the client.

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