Nursing Elites

1. The nurse is using the CAGE questionnaire as a screening tool for a client who is seeking help because his wife said he had a drinking problem. What information should the nurse explore in-depth with the client based on this screening tool?

• A. Consumption, liver enzymes, gastrointestinal complaints, and bleeding.
• B. Minimizing drinking, frequently missing family events, guilt about drinking, and amount of daily intake.
• C. Cancer screening results, anger, gastritis, daily alcohol intake.
• D. Efforts to cut down, annoyance with questions, guilt, drinking as an “Eye-opener.”

Correct answer: D

Rationale: The correct answer is D. The CAGE questionnaire is a screening tool for alcohol use disorder. Each letter in CAGE represents a key question: Cutting down, Annoyance by criticisms, Guilty feelings, and Eye-openers. These questions help assess problematic drinking behaviors and can provide valuable insights into the client's alcohol consumption habits. Choices A, B, and C do not directly align with the specific areas of inquiry covered by the CAGE questionnaire, making them incorrect. Therefore, the nurse should focus on exploring the client's efforts to cut down, annoyance with questions, feelings of guilt, and the use of alcohol as an “Eye-opener” based on this screening tool.

2. An RN is providing education to the family of a client diagnosed with schizophrenia who is being treated with clozapine (Clozaril). The RN should instruct the family to report which symptom immediately?

• A. Sore throat
• B. Weight loss
• C. Constipation
• D. Lightheadedness

Correct answer: A

Rationale: The correct answer is A: Sore throat. Clozapine can lead to agranulocytosis, a condition characterized by a significant decrease in white blood cells. A sore throat can be an early sign of agranulocytosis, a potentially life-threatening adverse effect of clozapine. The family should report this symptom immediately to the healthcare provider for further evaluation and management. Choices B, C, and D are incorrect because weight loss, constipation, and lightheadedness are not typically associated with the serious adverse effect of agranulocytosis related to clozapine therapy.

3. The client states, “It seems strange that I don’t have a TV in my room.” Which statement would be best for the nurse to provide?

• A. You can watch TV as much as you want outside of your room.
• B. Sometimes clients feel like the TV is sending them messages.
• C. It’s important to be out of your room and talking to others.
• D. Watching TV is a passive activity and we want you to be active.

Correct answer: B

Rationale: The correct answer is B because clients with depression or psychosis may interpret TV as sending messages, so it is often removed to prevent this risk. Choice A is incorrect because it does not address the client's concern and may not be feasible. Choice C is incorrect because it diverts from the client's immediate issue regarding the TV. Choice D is incorrect because it does not address the client's specific concern and instead focuses on the activity level.

4. 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.

5. A young adult male is hospitalized due to depression and an attempted suicide. The client reports that he lost his job and was angry with his employer for firing him when he took an overdose of pain medications. Which behavior best indicates to the nurse that his condition is improving?

• A. Initiates interactions with other clients.
• B. Describes verbally when he is angry.
• C. Participates in a job search with a social worker.
• D. Denies plans to harm himself or others.

Correct answer: A

Rationale: The best indicator of improvement in a client with depression is initiating interactions with others. This behavior demonstrates that the client is becoming less withdrawn and more self-directed, showing an improvement in social engagement and coping mechanisms. Choice B, describing anger verbally, may show some progress in emotional expression but does not necessarily indicate overall improvement in depression. Choice C, participating in a job search with a social worker, may be positive but does not directly address social interactions, which are crucial for improving depression. Choice D, denying plans to harm himself or others, is important for safety but does not directly reflect improvement in the client's social functioning or coping skills.

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