Nursing Elites

1. A client is being educated by a healthcare professional about initiating a prescribed abstinence therapy using Disulfiram (Antabuse). What information should the client acknowledge understanding?

• A. Admit to others that they are a substance abuser.
• B. Remain alcohol-free for 12 hours before taking the first dose.
• C. Attend monthly Alcoholics Anonymous meetings.
• D. Completely abstain from heroin or cocaine use.

Correct answer: B

Rationale: B: Before starting Disulfiram therapy, it is crucial for clients to be alcohol-free for a minimum of 12 hours to prevent adverse reactions. A: Admitting substance abuse is important, but it is not directly linked to the initiation of Disulfiram therapy. C: Attending Alcoholics Anonymous meetings is beneficial for support but not a specific requirement for starting Disulfiram. D: The focus of Disulfiram therapy is on alcohol abstinence, so abstaining from heroin or cocaine is not directly related to this medication.

2. A male client approaches the RN with an angry expression on his face and raises his voice, saying, “My roommate is the most selfish, self-centered, angry person I have ever met. If he loses his temper one more time with me, I am going to punch him out!” The RN recognizes that the client is using which defense mechanism?

• A. Denial.
• B. Projection.
• C. Rationalization.
• D. Splitting.

Correct answer: B

Rationale: The correct answer is B: Projection. Projection involves attributing one's own unacceptable feelings or thoughts to others, as seen in the client’s accusations of his roommate’s behavior. In this scenario, the client is projecting his own anger and potential for violence onto his roommate. Choice A, Denial, involves refusing to acknowledge some aspect of reality, which is not evident in the scenario. Choice C, Rationalization, is a defense mechanism where logical reasons are given to justify behaviors that are actually based on unacceptable motives, which is not demonstrated by the client's behavior. Choice D, Splitting, is a defense mechanism where a person sees others as all good or all bad, not applicable in this case as the client is not portraying extreme views of his roommate.

3. Pablo is a homeless adult who has no family connections. Pablo passed out on the street, and emergency medical services took him to the hospital where he expresses a wish to die. The physician recognizes evidence of substance use problems and mental health issues and recommends inpatient treatment for Pablo. What is the rationale for this treatment choice? Select all that apply.

• A. Intermittent supervision is available in inpatient settings.
• B. He requires stabilization of multiple symptoms.
• C. He has nutritional and self-care needs.
• D. Medication adherence will be mandated.

Correct answer: A

Rationale: The correct answer is A. In inpatient settings, there is continuous supervision available, ensuring safety and comprehensive care for individuals like Pablo who may be at risk due to substance use problems, mental health issues, and expressing a wish to die. Choice B is incorrect because the need for stabilization of multiple symptoms alone is not the primary rationale for inpatient treatment. Choice C is incorrect as although self-care and nutritional needs are important, they do not solely justify inpatient treatment. Choice D is incorrect because while medication adherence can be monitored in inpatient settings, it is not the primary rationale for choosing inpatient treatment for Pablo in this scenario.

4. A female client on a psychiatric unit is sweating profusely while vigorously doing push-ups and then running the length of the corridor several times before crashing into furniture in the sitting room. Picking herself up, she begins to toss chairs aside, looking for a red one to sit in. When another client objects to the disturbance, the client shouts, “I am the boss here. I do what I want.” Which nursing problem best supports these observations?

• A. Deficient diversional activity related to excess energy level.
• B. Disturbed personal identity related to grandiosity.
• C. Risk for activity intolerance related to hyperactivity.
• D. Risk for other-directed violence related to disruptive behaviors.

Correct answer: D

Rationale: The client's behavior of engaging in disruptive and aggressive actions, as well as claiming authority over others in the setting, indicates a risk for other-directed violence. This behavior poses a potential threat to the safety of others in the environment. Choice A is incorrect as the client's behavior is not solely indicative of a lack of diversional activities but rather a more serious issue. Choice B is incorrect as the behavior described does not primarily reflect disturbances in personal identity but rather displays of power and aggression. Choice C is incorrect as the client's actions do not suggest an intolerance to activity but rather an excessive and potentially harmful level of hyperactivity.

5. The nurse on the day shift receives report about a client with depression who was found on the floor in the morning. What intervention is best for the nurse to implement?

• A. Assist the client to get out of bed and involved in an activity.
• B. Monitor the client’s appetite and sleep patterns.
• C. Assess the client’s feelings regarding the hospital stay.
• D. Explain that staff will check on the client every 30 minutes.

Correct answer: A

Rationale: Assisting the client to engage in activities is the best intervention as it can help improve mood and prevent further decline in function. This intervention can also help the client regain a sense of control and purpose. Option B, monitoring appetite and sleep patterns, is important but not the most immediate intervention needed in this situation. Option C, assessing feelings about the hospital stay, is also important but addressing the client's physical safety and well-being should take precedence. Option D, explaining the frequency of staff checks, is not as effective in addressing the client's immediate needs for engagement and support.

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