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. A male adolescent was admitted to the unit two days ago for depression. When the mental health nurse tries to interview the client to establish rapport, he becomes very irritated and sarcastic. Which action is best for the nurse to take?

• A. Offer to play a game of cards with the client.
• B. Report the behavior to the next shift.
• C. Document the behavior in the chart.
• D. Plan to talk with the client the next day.

Correct answer: A

Rationale: Offering to play a game of cards with the adolescent is the best action for the nurse to take in this situation. Engaging in an activity like playing a game can help establish rapport with the adolescent as it provides a more relaxed and non-threatening environment for communication. This approach can help the adolescent feel more comfortable and open up, as adolescents often find it easier to communicate when involved in an activity. Reporting the behavior to the next shift, documenting the behavior, or planning to talk with the client the next day do not directly address the immediate need to establish rapport and improve communication with the adolescent.

3. The RN is preparing medications for a client with bipolar disorder and notices that the client discontinued antipsychotic medication for several days. Which medication should also be discontinued?

• A. Lithium (Lithotabs).
• B. Benztropine (Cogentin).
• C. Alprazolam (Xanax).
• D. Magnesium (Milk of Magnesia).

Correct answer: B

Rationale: The correct answer is Benztropine (Cogentin). Benztropine is commonly prescribed to manage side effects of antipsychotic medications. Therefore, if the antipsychotic medication is discontinued, there would be no need for Benztropine. Lithium is a mood stabilizer used in bipolar disorder, not directly related to antipsychotic use. Alprazolam is an anxiolytic, and Magnesium (Milk of Magnesia) is a laxative, neither of which is typically associated with antipsychotic medication use.

4. 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.

5. James is a 42-year-old patient with schizophrenia. He approaches you as you arrive for day shift and anxiously reports, 'Last night, demons came to my room and tried to rape me.' Which response would be most therapeutic?

• A. There are no such things as demons. What you saw were hallucinations.
• B. It is not possible for anyone to enter your room at night. You are safe here.
• C. You seem very upset. Please tell me more about what you experienced last night.
• D. That must have been very frightening, but we will check on you at night and you will be safe.

Correct answer: C

Rationale: Choice C is the most therapeutic response as it acknowledges the patient's feelings and encourages further exploration of their experience. By expressing empathy and inviting James to share more about what he experienced, it helps build trust and rapport. Choices A and B dismiss the patient's experience and can make them feel invalidated, which is not helpful in establishing a therapeutic relationship. Choice D acknowledges the fear but does not actively engage the patient in discussing their feelings and experiences, missing an opportunity for therapeutic communication.

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