Nursing Elites

1. An adolescent with a history of bipolar disorder is hospitalized during a manic episode. Which intervention is most appropriate for the nurse to include in the care plan?

• A. Encourage high levels of physical activity.
• B. Provide a quiet and structured environment.
• C. Engage the client in creative arts activities.
• D. Allow the client to make decisions about their schedule.

Correct answer: B

Rationale: During a manic episode, individuals with bipolar disorder may experience heightened energy levels, decreased need for sleep, and racing thoughts. Providing a quiet and structured environment is crucial in managing these symptoms as it helps reduce external stimuli, prevent overstimulation, and promote a sense of calmness. Encouraging high levels of physical activity may exacerbate the manic symptoms by further increasing stimulation and excitement. Engaging the client in creative arts activities might be beneficial during stable periods but may not be the most appropriate intervention during a manic episode. Allowing the client to make decisions about their schedule could potentially lead to impulsivity and poor judgment, which are common characteristics of mania.

2. A client with alcohol use disorder is being treated in a rehabilitation facility. Which behavior indicates that the client is making progress in recovery?

• A. Attends all scheduled therapy sessions regularly.
• B. Is participating in group therapy and sharing experiences.
• C. Completes a work-study program.
• D. Has a decreased need for psychiatric medication.

Correct answer: B

Rationale: The correct answer is B. Participation in group therapy and sharing experiences is a positive sign of progress in recovery for a client with alcohol use disorder. It fosters peer support, allows for personal insight, and encourages social interaction, which are essential aspects of the recovery process. Attending all scheduled therapy sessions regularly (Choice A) is important but may not necessarily indicate the same level of progress as active participation in group therapy. Completing a work-study program (Choice C) is not directly related to the client's recovery from alcohol use disorder. Having a decreased need for psychiatric medication (Choice D) is not necessarily a reliable indicator of progress in recovery from alcohol use disorder, as medication management is a separate aspect of treatment.

3. An elderly client is admitted to the psychiatric unit with a diagnosis of major depressive disorder. Which assessment finding is most concerning for the nurse?

• A. Weight loss of 5 pounds in one week.
• B. Lack of interest in previously enjoyed activities.
• C. Disorganized speech and thought processes.
• D. Severe fatigue and low energy levels.

Correct answer: C

Rationale: In an elderly client with major depressive disorder, disorganized speech and thought processes are the most concerning assessment findings for the nurse. These symptoms can suggest a more severe condition such as psychosis or cognitive impairment, which require immediate attention and intervention. While weight loss, lack of interest in activities, severe fatigue, and low energy levels are common symptoms of major depressive disorder, they do not pose an immediate risk as disorganized speech and thought processes do. Therefore, the nurse should prioritize addressing the disorganized speech and thought processes to ensure the safety and well-being of the client.

4. Which actions are likely to help promote the self-esteem of a male client with major depression?

• A. Ask the client about his long-term goals.
• B. Discuss the challenges of his medical condition.
• C. Include the client in determining treatment protocol.
• D. Encourage the client to engage in recreational therapy.

Correct answer: C

Rationale: Including the client in determining the treatment protocol is the most suitable action to promote the self-esteem of a male client with major depression. This approach empowers the client, involves him in decision-making regarding his care, and fosters a sense of control and self-worth. Option A, asking about his long-term goals, may not directly address his immediate self-esteem needs related to his current condition. Option B, discussing the challenges of his medical condition, may inadvertently focus on negative aspects and potentially lower self-esteem. Option D, encouraging engagement in recreational therapy, is beneficial but may not directly address the client's sense of control and self-worth in decision-making related to his treatment.

5. A mental health worker is caring for a client with escalating aggressive behavior. Which action by the mental health worker warrants immediate intervention by the RN?

• A. Attempting to physically restrain the client.
• B. Remaining at a distance of 4 feet from the client.
• C. Telling the client to go to the quiet area of the unit.
• D. Using a loud voice to communicate with the client.

Correct answer: A

Rationale: Attempting to physically restrain the client without proper protocol and preparation can escalate the situation. This can lead to increased agitation and aggression in the client, potentially putting both the client and the mental health worker at risk. Remaining at a distance, directing the client to a quiet area, or using a loud voice are all strategies that can be used to de-escalate the situation and ensure safety without resorting to physical intervention. Therefore, the immediate intervention is needed when the mental health worker attempts to physically restrain the client. Option B, remaining at a distance, is a safe practice to ensure personal safety. Option C, directing the client to a quiet area, is a de-escalation technique to create a calmer environment. Option D, using a loud voice, may be necessary to establish boundaries and ensure the client can hear instructions clearly.

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