Nursing Elites

1. An antidepressant medication is prescribed for a client who reports sleeping only 4 hours in the past 2 days and weight loss of 9 lbs within the last month. Which client goal is most important to achieve within the first three days of treatment?

• A. Meet scheduled appointments with a dietitian.
• B. Sleep at least 6 hours a night.
• C. Understand the purpose of the medication regimen.
• D. Describe the reasons for hospitalization.

Correct answer: B

Rationale: The most important goal to achieve within the first three days of treatment is to ensure the client can sleep at least 6 hours a night. Adequate sleep is essential for stabilizing mood and improving overall functioning. Improving sleep patterns is crucial to address the reported sleep deficit and weight loss associated with depression. Choice A is not as urgent as improving sleep patterns. Choice C is important but not as immediate as addressing the sleep deficit. Choice D is unrelated to the immediate treatment goal of improving sleep and managing symptoms of depression.

2. Following involvement in a motor vehicle collision, a middle-aged adult client is admitted to the hospital with multiple facial fractures. The client’s blood alcohol level is high on admission. Which PRN prescription should be administered if the client begins to exhibit signs and symptoms of delirium tremens (DT)?

• A. Hydromorphone (Dilaudid) 2 mg IM
• B. Prochlorperazine (Compazine) 5 mg IM
• C. Chlorpromazine (Thorazine) 50 mg IM
• D. Lorazepam (Ativan) 2 mg IM

Correct answer: D

Rationale: Delirium tremens (DT) is a severe form of alcohol withdrawal that can occur in individuals with high blood alcohol levels. Lorazepam (Ativan) is the preferred medication for managing DT due to its efficacy in reducing symptoms such as agitation, hallucinations, and autonomic instability. Hydromorphone, Prochlorperazine, and Chlorpromazine are not indicated for the treatment of delirium tremens. Hydromorphone is an opioid analgesic, Prochlorperazine is an antiemetic, and Chlorpromazine is an antipsychotic. Therefore, the correct choice is Lorazepam (Ativan) to address the symptoms associated with delirium tremens effectively.

3. A client who is admitted with a closed head injury after a fall has a blood alcohol level (BAL) of 0.28 (28%) and is difficult to arouse. Which intervention during the first 6 hours following admission should the nurse identify as the priority?

• A. Place in a side-lying position with head of bed elevated.
• B. Administer disulfiram (Antabuse) immediately
• C. Give lorazepam (Ativan) PRN for signs of withdrawal.
• D. Provide thiamine and folate supplements as prescribed.

Correct answer: A

Rationale: Maintain the patient's airway is the priority for a client who is intoxicated and obtunded.

4. Child protective services have removed 10-year-old Christopher from his parents' home due to neglect. Christopher reveals to the nurse that he considers the woman next door his 'nice' mom, that he loves school, and gets above-average grades. The strongest explanation of this response is:

• A. Temperament
• B. Genetic factors
• C. Resilience
• D. Paradoxical effects of neglect

Correct answer: C

Rationale: Resilience is the ability to adapt and cope with adverse situations. In this case, Christopher's positive outlook, love for school, and good academic performance despite experiencing neglect demonstrate resilience. Choice A, 'Temperament,' refers to an individual's natural behavioral style and would not fully explain Christopher's response. Genetic factors (Choice B) are not directly related to his ability to cope with neglect. Choice D, 'Paradoxical effects of neglect,' does not fit the situation as Christopher's positive response is more indicative of resilience than paradoxical effects.

5. The healthcare provider documents the mental status of a female client who has been hospitalized for several days by court order. The client states, “I don’t need to be here” and tells the healthcare provider that she believes that the television talks to her. The healthcare provider should document these assessment findings in which section of the mental status exam?

• A. Level of concentration
• B. Insight and judgment
• C. Remote memory
• D. Mood and affect

Correct answer: B

Rationale: Insight and judgment should be documented as these findings assess the client’s awareness of their need for treatment and understanding of their condition. In this scenario, the client’s statement of not needing to be hospitalized and belief that the television talks to her reflect her insight into her situation and judgment regarding reality. The other options are incorrect: Level of concentration refers to the ability to focus and maintain attention; Remote memory evaluates the recall of past events and information; Mood and affect assess emotional state and expression, which are not directly reflected in the client's statements about her need for hospitalization and belief about the television.

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