Nursing Elites

1. A nurse is assessing a client with dementia who is showing signs of increased confusion and agitation in the late afternoon. What is the most likely explanation for the client's symptoms?

• A. Anxiety
• B. Depression
• C. Sun-downing syndrome
• D. Medication side effects

Correct answer: C

Rationale: The correct answer is C: Sun-downing syndrome. Sun-downing syndrome is a phenomenon commonly seen in individuals with dementia, where they exhibit increased confusion and agitation in the late afternoon or evening. This pattern of behavior is believed to be linked to disruptions in the circadian rhythm and can be triggered by factors such as fatigue, low lighting, or increased shadows during the evening. Choices A and B, anxiety and depression, may be comorbid conditions in individuals with dementia but are not the primary explanation for the symptoms described. While medication side effects (Choice D) should always be considered in a client with dementia, given the time-specific nature of the symptoms, sun-downing syndrome is the most likely explanation in this case.

2. A client with bipolar disorder is being discharged with a prescription for lithium. What is the most important instruction the nurse should provide?

• A. Avoid foods high in sodium.
• B. Drink plenty of fluids, especially during hot weather.
• C. Take your medication with food.
• D. Monitor your blood pressure regularly.

Correct answer: B

Rationale: The correct answer is to instruct the client to drink plenty of fluids, especially during hot weather. Maintaining adequate hydration is crucial for clients taking lithium as dehydration can lead to lithium toxicity. Choice A is incorrect because while it is important to monitor sodium intake, staying hydrated is more critical. Choice C is incorrect as lithium is usually recommended to be taken with food to reduce stomach upset. Choice D is also important but not the most crucial instruction compared to ensuring proper hydration.

3. Which action is most important for the nurse to implement during the initial interview for a client who is admitted to the mental health unit?

• A. Establish rapport in each phase of the nurse-client relationship.
• B. Determine the client's ability to communicate effectively.
• C. Reflect on previous psychiatric interviews the nurse has performed.
• D. Ensure data is collected and recorded in a systematic sequence.

Correct answer: A

Rationale: Establishing rapport is the most important action during the initial interview for a client admitted to the mental health unit. Building rapport helps create a trusting relationship between the nurse and the client, which is essential for effective communication and the success of the therapeutic relationship. Choice B, determining the client's ability to communicate effectively, is important but secondary to establishing rapport. Choice C, reflecting on previous psychiatric interviews, is not as critical during the initial interview with a new client. Choice D, ensuring data collection and recording in a systematic sequence, is important but comes after establishing rapport to foster a therapeutic environment.

4. An outpatient clinic that has been receiving haloperidol (Haldol) for 2 days develops muscular rigidity, altered consciousness, a temperature of 103, and trouble breathing on day 3. The LPN/LVN interprets these findings as indicating which of the following?

• A. Neuroleptic Malignant Syndrome
• B. Tardive dyskinesia
• C. Extrapyramidal adverse effects
• D. Drug-induced parkinsonism

Correct answer: A

Rationale: Neuroleptic Malignant Syndrome (NMS) is a life-threatening condition characterized by hyperthermia, muscle rigidity, altered consciousness, and autonomic dysregulation. It is a rare but serious side effect of antipsychotic medications like haloperidol (Haldol). NMS requires immediate intervention, including discontinuation of the offending medication and supportive care. Tardive dyskinesia (Choice B) is a different condition characterized by involuntary movements of the face and extremities that can occur with long-term antipsychotic use. Extrapyramidal adverse effects (Choice C) encompass a range of movement disorders like dystonia, akathisia, and parkinsonism that can result from antipsychotic medications, but they do not present with hyperthermia and altered consciousness as in NMS. Drug-induced parkinsonism (Choice D) is a form of parkinsonism caused by certain medications, but it typically presents with symptoms similar to Parkinson's disease, such as tremor, bradykinesia, and rigidity, without the severe hyperthermia and autonomic dysregulation seen in NMS.

5. When developing a plan of care for a client in the psychiatric unit following aspiration of a caustic material related to a suicide attempt, which nursing diagnosis has the highest priority?

• A. Risk for injury.
• B. Ineffective coping mechanisms.
• C. Alteration in comfort.
• D. Ineffective breathing patterns.

Correct answer: D

Rationale: When a client aspirates a caustic material, the priority nursing diagnosis should focus on addressing physiological concerns, particularly related to breathing patterns. Aspiration of caustic material can lead to airway compromise, respiratory distress, and potential lung damage. Therefore, monitoring and addressing ineffective breathing patterns are crucial for ensuring the client's immediate safety and well-being. Choices A, B, and C are important considerations in psychiatric care but are secondary to the critical physiological issue of ineffective breathing patterns in this scenario.

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