Nursing Elites

1. The nurse is leading a 'current events group' with chronic psychiatric clients. One group member states, 'Clara Barton was my nurse during my last hospitalization. She was a very mean nurse and wasn't nice to me.' Which response would be best for the nurse to make?

• A. 'Clara Barton was not your nurse.'
• B. 'What did she do to you that was so mean?'
• C. 'I didn't know that Clara Barton was a nurse.'
• D. 'Clara Barton started the American Red Cross.'

Correct answer: D

Rationale: (D) presents the reality of the situation in relation to American culture. The fact that Clara Barton was a nurse during the Civil War should be addressed on an individual basis. Since this is group therapy, the nurse would be illustrating the concept of universality. (A) is likely to promote defensiveness. (B and C) would support the delusion. Therefore, the most appropriate response is (D) as it provides factual information that can redirect the conversation in a constructive manner.

2. A client is diagnosed with schizophrenia and exhibits apathy, lack of energy, and lack of interest in daily activities. The nurse should recognize that these symptoms are most likely due to which of the following?

• A. Negative symptoms of schizophrenia.
• B. Positive symptoms of schizophrenia.
• C. Side effects of antipsychotic medication.
• D. Symptoms of depression.

Correct answer: A

Rationale: Apathy, lack of energy, and lack of interest in daily activities are negative symptoms of schizophrenia (A). Positive symptoms of schizophrenia include hallucinations and delusions (B). While antipsychotic medication side effects can sometimes cause lethargy or sedation (C), the scenario specifically describes negative symptoms. Depression can also cause similar symptoms (D), but in the context of schizophrenia, these are recognized as negative symptoms.

3. A client with borderline personality disorder is admitted to the psychiatric unit after a suicide attempt. The client frequently expresses feelings of emptiness and fears of abandonment. What is the most therapeutic nursing approach for this client?

• A. Encourage the client to participate in all group activities.
• B. Set clear and consistent boundaries while providing empathy.
• C. Reassure the client that the staff will not abandon them.
• D. Explore the client's past relationships in depth.

Correct answer: B

Rationale: The most therapeutic nursing approach for a client with borderline personality disorder, who frequently expresses feelings of emptiness and fears of abandonment, is to set clear and consistent boundaries while providing empathy. This approach helps manage the client's fear of abandonment and feelings of emptiness, which are common in borderline personality disorder. Option A may overwhelm the client in a group setting without addressing their specific needs. Option C, while well-intentioned, may not fully address the underlying issues and may create dependency. Option D delves into the client's past relationships, which may be inappropriate and trigger emotional distress in a vulnerable client.

4. A client with bipolar disorder is experiencing a manic episode. Which nursing intervention is most appropriate?

• A. Encourage group activities to decrease isolation.
• B. Provide a structured environment with routine activities.
• C. Limit the client's physical activity to prevent exhaustion.
• D. Allow the client to choose activities freely.

Correct answer: B

Rationale: During a manic episode, individuals with bipolar disorder may exhibit excessive energy, impulsivity, and disorganized behavior. Providing a structured environment with routine activities is the most appropriate nursing intervention. This approach can help regulate the client's behavior, reduce impulsivity, and prevent engaging in potentially harmful activities. Encouraging group activities (Choice A) may exacerbate the client's symptoms due to overstimulation. Limiting physical activity (Choice C) may not address the need for structure and routine during a manic episode. Allowing the client to choose activities freely (Choice D) can lead to impulsive decision-making and may not provide the necessary boundaries required to manage the manic symptoms effectively.

5. The LPN/LVN is caring for a client who has been prescribed a monoamine oxidase inhibitor (MAOI) for depression. Which statement by the client indicates a need for further teaching?

• A. I need to avoid foods that are high in tyramine, like aged cheese and cured meats.
• B. I should take this medication with food to avoid nausea.
• C. I can drink alcohol in moderation while taking this medication.
• D. I can stop taking this medication once I feel better.

Correct answer: C

Rationale: The statement 'I can drink alcohol in moderation while taking this medication' indicates a need for further teaching because alcohol consumption can have dangerous interactions with MAOIs. MAOIs can interact with alcohol to cause a hypertensive crisis, which can be life-threatening. Choices A and B are correct statements as avoiding tyramine-rich foods and taking the medication with food can help prevent adverse effects. Choice D is incorrect because abruptly stopping an antidepressant medication like an MAOI can lead to withdrawal symptoms and a relapse of depression.

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