Nursing Elites

1. A nurse is planning care for several clients attending community-based mental health programs. Which of the following clients should the nurse visit first?

• A. A client who received a burn on the arm while using a hot iron at home
• B. A client who requests a change of antipsychotic medication due to new adverse effects
• C. A client who reports hearing a voice saying that life is not worth living anymore
• D. A client who tells the nurse about experiencing manifestations of severe anxiety before and during a job interview

Correct answer: C

Rationale: The nurse should visit the client who reports hearing a voice saying that life is not worth living anymore first. This statement indicates potential suicidal ideation, which requires immediate intervention to ensure the client's safety. Choices A, B, and D do not present an immediate threat to the client's life. While burns, adverse effects of medication, and severe anxiety are important concerns, they do not pose an immediate risk of self-harm or suicide.

2. A patient with agoraphobia has difficulty leaving their home. Which nursing intervention would be most effective?

• A. Encourage the patient to make small, gradual steps outside the home.
• B. Advise the patient to avoid crowded places.
• C. Suggest that the patient focus on their breathing when anxious.
• D. Provide the patient with information about support groups.

Correct answer: A

Rationale: Encouraging the patient to make small, gradual steps outside the home is the most effective nursing intervention for agoraphobia. This approach helps the patient confront their fear gradually and build confidence in managing their symptoms. By taking small steps, the patient can start to expand their comfort zone and reduce anxiety associated with leaving their home, ultimately aiding in their recovery and increasing their independence. Choices B, C, and D are not as effective as choice A. Advising the patient to avoid crowded places does not address the underlying issue of agoraphobia. Suggesting that the patient focus on their breathing when anxious may help manage immediate symptoms but does not address the fear of leaving home. Providing information about support groups is beneficial but may not directly address the patient's difficulty leaving their home.

3. A healthcare professional is assessing a patient with anorexia nervosa. Which finding is most concerning?

• A. Mild bradycardia
• B. Electrolyte imbalances
• C. Slight hypotension
• D. Lanugo

Correct answer: B

Rationale: Electrolyte imbalances are a critical concern in patients with anorexia nervosa due to the potential for severe complications such as cardiac arrhythmias, muscle weakness, and neurological disturbances. Prompt identification and management of electrolyte imbalances are essential to prevent life-threatening outcomes.

4. Which intervention is most appropriate to promote the self-esteem of a patient with severe depression?

• A. Encouraging the patient to spend time alone for self-reflection.
• B. Involving the patient in simple, achievable activities to ensure success.
• C. Allowing the patient to rest and avoid responsibilities.
• D. Providing frequent reassurances and compliments.

Correct answer: B

Rationale: Involving the patient in simple, achievable activities is a constructive approach to promote self-esteem by fostering a sense of accomplishment and success. This method encourages positive reinforcement and helps the patient regain confidence and self-worth, which are essential in managing depression. Choice A could potentially lead to rumination and worsen depressive symptoms. Choice C might reinforce avoidance behaviors and hinder progress. Choice D, while supportive, may not address the core need for building self-esteem through personal achievements.

5. In schizophrenia, a patient is experiencing negative symptoms. Which of the following is a negative symptom?

• A. Hallucinations
• B. Delusions
• C. Apathy
• D. Disorganized speech

Correct answer: C

Rationale: In schizophrenia, negative symptoms refer to deficits in normal emotional responses or other thought processes. Apathy is a negative symptom characterized by a lack of interest, enthusiasm, or concern. Hallucinations (seeing or hearing things that aren't there), delusions (false beliefs), and disorganized speech are positive symptoms, which involve the presence of abnormal behaviors or thoughts.

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