Nursing Elites

1. A nurse determines that the wife of an alcoholic client is benefitting from attending an Al-Anon group when the nurse hears the wife say:

• A. I no longer feel that I deserve the meetings my husband inflicts on me.
• B. My attendance at the meetings has helped me to see that I provoke my husband's violence.
• C. I enjoy attending the meetings because they get me out of the house and away from my husband.
• D. I can tolerate my husband's destructive behaviors now that I know they are common with alcoholics.

Correct answer: A

Rationale: Choice A is the correct answer as the statement indicates the wife understands that her husband's behavior is not her fault and is benefitting from the group support. Choice B is incorrect as it suggests self-blame rather than recognizing the husband's responsibility. Choice C is incorrect as the benefit is related to emotional support and understanding, not just getting away from the husband. Choice D is incorrect as tolerating destructive behaviors is not a healthy outcome of attending support groups.

2. A client with schizophrenia is experiencing distressful thoughts secondary to paranoia. Which intervention(s) should the LPN/LVN include in the plan of care? Select one intervention that does not apply.

• A. Avoid laughing when near the client
• B. Whisper when communicating near the client
• C. Increase socialization of the client among peers
• D. Have the client sign a written release of information form

Correct answer: B

Rationale: The correct intervention for a client with schizophrenia experiencing distressful thoughts secondary to paranoia is to avoid laughing when near the client. This is important as laughter can be misinterpreted and exacerbate the client's paranoia. Whispering when communicating near the client is not an appropriate intervention as it may lead the client to think secretive or negative information is being shared about them, further fueling their paranoia. Increasing socialization among peers can help provide support and reduce feelings of isolation, while having the client sign a written release of information form is not directly related to managing paranoia and distressful thoughts.

3. A moderately depressed client who was hospitalized 2 days ago suddenly begins smiling and reporting that the crisis is over. The client says to a nurse, 'I'm finally cured.' The LPN/LVN interprets this behavior as a cue to modify the treatment plan by:

• A. Suggesting a reduction of medication
• B. Allowing increased 'in-room' activities
• C. Increasing the level of suicide precautions
• D. Allowing the client off-unit privileges as needed

Correct answer: C

Rationale: A sudden improvement in mood and declaring being cured can be warning signs of a decision to attempt suicide. Therefore, the appropriate action would be to increase the level of suicide precautions to ensure the safety of the client. This can involve closer monitoring and restriction of items that could be harmful. Choices A, B, and D are incorrect as they do not address the potential risk of suicide that may be present with the sudden change in behavior.

4. A client with borderline personality disorder is admitted to the psychiatric unit after a suicide attempt. The client frequently expresses feelings of emptiness and fears of abandonment. What is the most therapeutic nursing approach for this client?

• A. Encourage the client to participate in all group activities.
• B. Set clear and consistent boundaries while providing empathy.
• C. Reassure the client that the staff will not abandon them.
• D. Explore the client's past relationships in depth.

Correct answer: B

Rationale: The most therapeutic nursing approach for a client with borderline personality disorder, who frequently expresses feelings of emptiness and fears of abandonment, is to set clear and consistent boundaries while providing empathy. This approach helps manage the client's fear of abandonment and feelings of emptiness, which are common in borderline personality disorder. Option A may overwhelm the client in a group setting without addressing their specific needs. Option C, while well-intentioned, may not fully address the underlying issues and may create dependency. Option D delves into the client's past relationships, which may be inappropriate and trigger emotional distress in a vulnerable client.

5. A male client with alcohol use disorder is admitted for detoxification. The nurse knows that which symptom is a sign of severe alcohol withdrawal?

• A. Bradycardia
• B. Seizures
• C. Hyperglycemia
• D. Constipation

Correct answer: B

Rationale: Seizures are a sign of severe alcohol withdrawal and can be life-threatening, requiring immediate medical attention. Bradycardia, hyperglycemia, and constipation are not typically associated with severe alcohol withdrawal. Bradycardia is more commonly seen in opioid withdrawal, hyperglycemia could be due to other reasons like uncontrolled diabetes, and constipation is not a typical symptom of severe alcohol withdrawal.

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