Nursing Elites

1. Tatiana has been hospitalized for an acute manic episode. On admission, the nurse suspects lithium toxicity. What assessment findings would indicate the nurse's suspicion as correct?

• A. Shortness of breath, gastrointestinal distress, chronic cough
• B. Ataxia, severe hypotension, large volume of dilute urine
• C. Gastrointestinal distress, thirst, nystagmus
• D. Electroencephalographic changes, chest pain, dizziness

Correct answer: B

Rationale: The correct answer is B. Ataxia, severe hypotension, and a large volume of dilute urine are classic signs of lithium toxicity. Ataxia refers to a lack of muscle coordination, severe hypotension indicates dangerously low blood pressure, and the large volume of dilute urine is a result of the kidneys' inability to concentrate urine properly, a common feature of lithium toxicity.

2. A client has been prescribed lithium for the treatment of bipolar disorder. Which of the following instructions should the nurse include?

• A. Avoid driving until you know how the medication affects you.
• B. Take the medication with food to prevent stomach upset.
• C. You may experience mild nausea when initiating the medication.
• D. Do not double the next dose if you miss one.

Correct answer: A

Rationale: The correct instruction for the nurse to provide is to advise the client to avoid driving until they know how the medication affects them. Lithium can lead to side effects like dizziness and drowsiness, which could impair one's ability to drive safely. Choice B is incorrect because lithium is usually taken on an empty stomach. Choice C may be true but is not as critical as the potential side effects affecting driving. Choice D is important but not as immediate as ensuring the client's safety while driving.

3. Which of the following statements about the DSM-5 is inaccurate?

• A. It includes specific criteria for diagnosing mental disorders.
• B. It is used by mental health professionals to guide diagnosis.
• C. It provides a classification system for mental disorders.
• D. It includes guidelines for the treatment of mental disorders.

Correct answer: D

Rationale: The DSM-5 is a diagnostic tool that provides specific criteria for diagnosing mental disorders, is utilized by mental health professionals to guide diagnosis, and offers a systematic classification of mental disorders. The statement that the DSM-5 includes guidelines for the treatment of mental disorders is inaccurate. The primary focus of the DSM-5 is on diagnosis and classification, not treatment. Therefore, choice D is the correct answer. Choices A, B, and C accurately describe the purpose and functions of the DSM-5.

4. After fasting from 10 p.m. the previous evening, a client finds out that the blood test has been canceled. The client swears at the nurse and states, 'You are incompetent!' Which is the nurse's best response?

• A. Do you believe that I was the cause of your blood test being canceled?
• B. I see that you are upset, but I feel uncomfortable when you swear at me.
• C. Have you ever thought about ways to express anger appropriately?
• D. I'll give you some space. Let me know if you need anything.

Correct answer: B

Rationale: In this scenario, the most appropriate response for the nurse is option B. By acknowledging the client's feelings and setting a boundary regarding inappropriate behavior, the nurse addresses the situation with empathy. This response demonstrates understanding of the client's emotions while also maintaining a professional standard by expressing discomfort with swearing. Option A could come off as defensive and may escalate the situation. Option C may be perceived as condescending and not immediately address the client's behavior. Option D, although offering space, does not directly address the inappropriate behavior and misses an opportunity to set a professional boundary.

5. A client is diagnosed with obsessive-compulsive disorder (OCD). Which of the following interventions should the nurse include in the care plan? Select one that does not apply.

• A. Allow the client to perform rituals initially
• B. Set limits on the time allowed for rituals
• C. Encourage the client to verbalize feelings
• D. Provide a structured schedule of activities

Correct answer: A

Rationale: Interventions for a client with OCD should include allowing the client to perform rituals initially, setting limits on the time allowed for rituals, encouraging the client to verbalize feelings, and providing a structured schedule of activities. Allowing the client to perform rituals is an essential part of managing OCD and should not be restricted in the initial stages of care. Setting limits on the time for rituals helps prevent excessive engagement in them. Encouraging the client to verbalize feelings promotes emotional expression and processing. Providing a structured schedule of activities helps establish routine and predictability, which can be beneficial for individuals with OCD.

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