Nursing Elites

1. The healthcare professional is preparing medications for a client with bipolar disorder and notices that the antipsychotic medication was discontinued several days ago. Which medication should also be discontinued?

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

Correct answer: B

Rationale: When an antipsychotic medication is discontinued, medications like Benztropine (Cogentin), which are given to reduce extrapyramidal side effects associated with traditional antipsychotic medications, should also be discontinued. Alprazolam (Xanax) is not directly related to antipsychotic medication use in this context. Magnesium (Milk of Magnesia) is a laxative and not typically indicated for bipolar disorder. Lithium (Lithotabs) is a mood stabilizer commonly used in bipolar disorder, and its discontinuation should be carefully managed under the guidance of a healthcare provider to prevent relapse of symptoms.

2. During an annual physical at the corporate clinic, a male employee expresses to the RN that his high-stress job is causing trouble in his personal life. He mentions getting so angry while driving to and from work that he has considered 'getting even' with other drivers. How should the RN respond?

• A. “Anger is contagious and could lead to major confrontations.”
• B. “Try not to let your anger cause you to act impulsively.”
• C. “Expressing your anger to a stranger could lead to an unsafe situation.”
• D. “It seems like there are many situations that make you feel angry.”

Correct answer: B

Rationale: The correct response for the RN is to advise the employee not to act impulsively when feeling angry. This approach helps the individual learn to manage anger in a constructive manner, reducing the likelihood of potential conflicts. Choice A is incorrect because although acknowledging that anger can escalate into confrontations is valid, it does not provide immediate guidance on managing the anger. Choice C focuses on the dangers of expressing anger to strangers but does not address the core issue of managing anger. Choice D simply acknowledges the employee's feelings without providing guidance on how to address the situation effectively.

3. During a group session on anger management, a male adolescent client is fidgety, interrupts peers, and talks about his pets at home. What action should the nurse take?

• A. Allow the client to leave and return in 10 minutes.
• B. Explore the client’s feelings about his pets and home life.
• C. Encourage his peers to help involve him in the activity.
• D. Redirect him by encouraging him to read from the handout.

Correct answer: D

Rationale: The best nursing action in this scenario is to redirect the client by encouraging him to read from the handout. This approach helps refocus the client's attention on the topic being discussed, which is anger management. Choice A is not appropriate as it may disrupt the group session and does not address the client's behavior. Choice B, while important in understanding the client's background, does not address the immediate disruptive behavior. Choice C involves others to manage the client's behavior instead of direct intervention by the nurse, which may not be effective in this situation.

4. A client with an eating disorder tells the RN, 'I’ve been eating only 400 calories per day and have been taking diuretics to lose weight.' What is the RN’s best response?

• A. “Your diet is very harmful and needs to be changed immediately.”
• B. “It’s important to monitor your calorie intake carefully.”
• C. “Have you noticed any physical effects from this low-calorie diet?”
• D. “The diuretics could be causing your body to lose essential nutrients.”

Correct answer: D

Rationale: The correct response is D. By addressing the potential harm of diuretics and the low-calorie diet, the nurse effectively addresses both aspects of the client's disordered eating behavior. Choice A is too direct and does not provide information on the specific issue of diuretics. Choice B focuses solely on monitoring calorie intake without addressing the use of diuretics. Choice C inquires about physical effects but does not address the overall risks associated with diuretics and low-calorie intake.

5. A male client with a long history of alcohol dependency arrives in the emergency department describing the feeling of bugs crawling on his body. His BP is 170/102, pulse rate is 110 bpm, and his blood alcohol level (BAL) is 0 mg/dl. Which medication should the nurse administer?

• A. Haloperidol (Haldol)
• B. Thiamine (Vitamin B1)
• C. Diphenhydramine (Benadryl)
• D. Lorazepam (Ativan)

Correct answer: D

Rationale: In this scenario, the client is experiencing hallucinations and symptoms of alcohol withdrawal. Lorazepam (Ativan) is the appropriate choice as it helps manage withdrawal symptoms, including hallucinations and elevated blood pressure in alcohol-dependent clients. Haloperidol (Haldol) (Choice A) is an antipsychotic but is not the first-line treatment for alcohol withdrawal symptoms. Thiamine (Vitamin B1) (Choice B) is essential in alcohol withdrawal treatment for preventing Wernicke's encephalopathy, but in this case, addressing the acute withdrawal symptoms is the priority. Diphenhydramine (Benadryl) (Choice C) is an antihistamine that may help with itching or mild anxiety but is not the preferred choice for managing alcohol withdrawal symptoms like hallucinations and elevated blood pressure.

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