Nursing Elites

1. A newly admitted client describes her mission in life as one of saving her son by eliminating the 'provocative sluts' of the world. There are several attractive young women on the unit. What should the LPN/LVN do first?

• A. Ask the client for her definition of 'provocative sluts'
• B. Ask the young female clients on the unit to dress less provocatively
• C. Ask the client to discuss her concerns in the next group session
• D. Ask the client to inform the staff if she has negative thoughts about other clients

Correct answer: D

Rationale: The correct action for the LPN/LVN to take first is to ask the client to inform the staff if she has negative thoughts about other clients. This approach is crucial as it helps in monitoring the client's thoughts and behaviors, potentially preventing any harmful actions towards others on the unit. Asking for the client's definition of 'provocative sluts' (Choice A) may not address the immediate concern of monitoring the client's harmful thoughts. Asking the young female clients to dress less provocatively (Choice B) is inappropriate and victim-blaming. Asking the client to discuss her concerns in the next group session (Choice C) may not be effective in addressing the potential harm the client's thoughts could pose to others on the unit.

2. An older homeless client visits the psychiatric clinic to obtain a prescription renewal for alprazolam (Xanax). During the health assessment, the client complains of chest pain. Which action should the RN take first?

• A. Refer the client to the cardiology unit.
• B. Obtain the client's blood pressure.
• C. Assess the client for substance abuse.
• D. Determine if Xanax was taken recently.

Correct answer: D

Rationale: Determining if Xanax was taken recently is crucial as it helps assess whether the chest pain is related to medication use or another issue, guiding appropriate immediate care. This action can provide essential information to address the client's current complaint effectively. Referring the client to the cardiology unit (Choice A) may be premature without assessing the Xanax use first. While obtaining the client's blood pressure (Choice B) is important, it is not the priority when the client presents with chest pain and a history of taking Xanax. Assessing the client for substance abuse (Choice C) is also important but is secondary to first determining the potential link between Xanax and the chest pain.

3. An adolescent with major depressive disorder has been taking duloxetine (Cymbalta) for the past 12 days. Which assessment finding requires immediate follow-up?

• A. Describes life as without purpose.
• B. Exhibits an increase in sweating.
• C. States is often fatigued and drowsy.
• D. Complains of nausea and loss of appetite.

Correct answer: A

Rationale: The correct answer is A. Expressing that life is without purpose can indicate deepening depression or suicidal ideation, which requires immediate attention. While sweating, fatigue, drowsiness, nausea, and loss of appetite can be side effects of duloxetine (Cymbalta), they do not indicate the same level of urgency as a statement suggesting deepening depression or suicidal ideation.

4. A female client with obsessive-compulsive disorder (OCD) is describing her obsessions and compulsions and asks the nurse why these make her feel safer. What information should the nurse include in this client's teaching plan? (select one that does not apply.)

• A. Compulsions relieve anxiety
• B. Anxiety is the key reason for OCD
• C. Obsessions cause compulsions
• D. Obsessive thoughts are linked to levels of neurochemicals

Correct answer: C

Rationale: The correct answer is C. Obsessions do not cause compulsions; rather, obsessions are intrusive, unwanted thoughts, images, or urges that trigger intensely distressing feelings, while compulsions are repetitive behaviors or mental acts that a person feels driven to perform in response to an obsession or according to rules that must be applied rigidly. Choices A, B, and D are incorrect. Choice A is incorrect because compulsions are behaviors or mental acts aimed at reducing distress or preventing a dreaded event or situation. Choice B is incorrect because while anxiety is often a significant component of OCD, it is not the only reason for the disorder. Choice D is incorrect because obsessive thoughts are not solely linked to levels of neurochemicals but are more complex and multifactorial.

5. A male adolescent is admitted with bipolar disorder after being released from jail for assault with a deadly weapon. When the nurse asks the teen to identify his reason for the assault, he replies, 'Because he made me mad!' Which goal is best for the nurse to include in the client's plan of care? The client will

• A. outline methods for managing anger.
• B. control impulsive actions toward self and others.
• C. verbalize feelings when anger occurs.
• D. recognize consequences for behaviors exhibited.

Correct answer: B

Rationale: In this scenario, the client's response indicates poor impulse control, a common issue in individuals with bipolar disorder. The most critical goal for the nurse to include in the client's plan of care is to help the client control impulsive actions toward self and others. This goal is essential for preventing harmful behaviors and mitigating the social consequences associated with impulsivity. While outlining methods for managing anger, verbalizing feelings when anger occurs, and recognizing consequences for behaviors exhibited are important aspects of therapy, they do not directly address the urgent need to control impulsive behavior in this case.

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