Nursing Elites

1. A client with schizophrenia is experiencing auditory hallucinations. What is the most appropriate nursing intervention?

• A. Encourage the client to ignore the voices.
• B. Ask the client what the voices are saying.
• C. Distract the client with a new activity.
• D. Tell the client that the voices are not real.

Correct answer: B

Rationale: Asking the client what the voices are saying is the most appropriate intervention as it helps the nurse assess the content of the hallucinations and the potential risk they may pose. Encouraging the client to ignore the voices (Choice A) may not address the underlying issue or provide valuable information for the nurse. Distracting the client with a new activity (Choice C) may temporarily divert attention but does not address the hallucinations. Telling the client that the voices are not real (Choice D) may invalidate the client's experience and can lead to distrust in the therapeutic relationship.

2. A 35-year-old male client on the psychiatric ward of a general hospital believes that someone is trying to poison him. The nurse understands that a client's delusions are most likely related to his

• A. early childhood experiences involving authority issues.
• B. anger about being hospitalized.
• C. low self-esteem.
• D. phobic fear of food.

Correct answer: C

Rationale: The correct answer is C: low self-esteem. Delusions of persecution, like being poisoned, are often rooted in underlying issues of low self-esteem and trust. Option A is incorrect because the delusion is not necessarily related to early childhood experiences involving authority issues. Option B is incorrect as there is no information provided that suggests the client's delusion is driven by anger about being hospitalized. Option D is incorrect as the delusion is about being poisoned, not a phobic fear of food.

3. The nurse is planning the care for a 32-year-old male client with acute depression. Which nursing intervention would be best in helping this client deal with his depression?

• A. Ensure that the client's day is filled with group activities.
• B. Assist the client in exploring feelings of shame, anger, and guilt.
• C. Allow the client to initiate and determine activities of daily living.
• D. Encourage the client to explore the rationale for his depression.

Correct answer: B

Rationale: Assisting the client in exploring feelings of shame, anger, and guilt (B) is the most appropriate intervention for acute depression as it helps address core emotions that may be contributing to the condition. Focusing on these emotions can aid the client in processing and coping with their feelings. Ensuring that the client's day is filled with group activities (A) might overwhelm the client, as they may not be ready for social interactions during this sensitive time. Allowing the client to initiate and determine activities of daily living (C) is more suitable for chronic cases where the client needs to regain autonomy. Encouraging the client to explore the rationale for his depression (D) is less effective in acute cases, as the focus should be on immediate emotional support and understanding rather than cognitive analysis.

4. A client with bipolar disorder is prescribed valproic acid (Depakote). What is the most important laboratory test for the LPN/LVN to monitor?

• A. Liver function tests.
• B. Kidney function tests.
• C. Thyroid function tests.
• D. Complete blood count.

Correct answer: A

Rationale: The correct answer is A: Liver function tests. Monitoring liver function tests is crucial for clients prescribed valproic acid (Depakote) due to the medication's potential to affect liver function and increase the risk of liver toxicity. While kidney function tests (choice B), thyroid function tests (choice C), and complete blood count (choice D) are important in various clinical scenarios, the priority when administering valproic acid is to monitor liver function to prevent adverse effects associated with this medication.

5. A 72-year-old female client is admitted to the psychiatric unit with a diagnosis of major depression. Which statement by the client should be of greatest concern to the nurse and require further assessment?

• A. "I will die if my cat dies."
• B. "I don't feel like eating this morning."
• C. "I just went to my friend's funeral."
• D. "Don't you have more important things to do?"

Correct answer: A

Rationale: Sometimes a client will use an analogy to describe themselves, and (A) would be an indication for conducting a suicide assessment. (B) could have a variety of etiologies, and while further assessment is indicated, this statement does not indicate potential suicide. The normal grief process differs from depression, and at this client's age, peer/cohort deaths are more frequent, so (C) would be within normal limits. (D) is an expression of low self-esteem typical of depression. Choices (B), (C), and (D) are examples of decreased energy and mood levels which would negate suicide ideation at this time.

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