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. In pediatric mental health, there is a lack of sufficient numbers of community-based resources and providers, resulting in long waiting lists for services. This has resulted in:

• A. Children of color and those in poor economic conditions being underserved
• B. Increased stress in the family unit
• C. Markedly increased funding
• D. Premature termination of services

Correct answer: D

Rationale: The correct answer is D, 'Premature termination of services.' The lack of sufficient numbers of community-based resources and providers, along with long waiting lists, can lead to premature termination of services for children in need of mental health support. Choice A, 'Children of color and those in poor economic conditions being underserved,' is not directly related to the consequence mentioned in the question. Choice B, 'Increased stress in the family unit,' while a potential consequence, is not explicitly stated in the question as a direct result of the lack of resources. Choice C, 'Markedly increased funding,' is not a consequence but rather a potential solution to address the lack of resources.

3. A male client is admitted to the psychiatric unit for recurrent negative symptoms of chronic schizophrenia and medication adjustment of risperidone (Risperdal). When the client walks to the nurse’s station in a laterally contracted position, he states that something has made his body contort into a monster. What action should the nurse take?

• A. Medicate the client with the prescribed antipsychotic thioridazine (Mellaril).
• B. Offer the client a prescribed physical therapy hot pack for muscle spasms.
• C. Administer the prescribed anticholinergic benztropine (Cogentin) for dystonia.
• D. Direct the client to occupational therapy to distract him from somatic complaints.

Correct answer: C

Rationale: The client is experiencing a dystonic reaction due to dopamine depletion, which is a known side effect of Risperidone. Dystonia presents as abnormal muscle contractions and postures. The immediate management for this side effect is the administration of an anticholinergic medication like Benztropine (Cogentin). Choice A is incorrect as thioridazine is not the recommended medication for dystonic reactions. Choice B is incorrect as a hot pack would not effectively address the underlying cause of the dystonic reaction. Choice D is incorrect as occupational therapy is not the appropriate intervention for managing acute dystonia.

4. What assessment question will provide healthcare providers with information regarding the effects of a woman's circadian rhythms on her quality of life?

• A. How much sleep do you usually get each night?
• B. Does your heart ever seem to skip a beat?
• C. When was the last time you had a fever?
• D. Do you have problems urinating?

Correct answer: A

Rationale: Asking about the amount of sleep a woman gets each night is crucial in understanding her circadian rhythms and how they may affect her quality of life. Circadian rhythms are the body's internal clock that regulates the sleep-wake cycle. Monitoring sleep patterns can provide insights into how well these rhythms are functioning and impacting daily life. Choices B, C, and D are unrelated to circadian rhythms and do not directly assess the effects of these rhythms on quality of life.

5. A male client with bipolar disorder tells the nurse that he needs to 'make some deals so that he can improve his retirement savings.' Based on this information, which client outcome should the nurse include in the plan of care?

• A. Delay business decisions until his mania subsides.
• B. Identify the feelings associated with his behaviors.
• C. Seek legal counsel when making business decisions.
• D. Describe why he is feeling fearful about his finances.

Correct answer: A

Rationale: In individuals with bipolar disorder experiencing mania, impulsivity and poor judgment are common. Delaying business decisions until the mania subsides is crucial to prevent impulsive and potentially harmful financial choices. Choice B, identifying feelings associated with behaviors, may be important but does not directly address the immediate need to prevent risky financial decisions. Seeking legal counsel (Choice C) may be appropriate in some situations but is not the priority in managing acute mania. Describing why he feels fearful about finances (Choice D) is relevant for understanding emotions but does not address the immediate risk of impulsive financial actions during mania.

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