Nursing Elites

1. The RN on the evening shift receives a report that a client is scheduled for electroconvulsive treatment (ECT) in the morning. Which intervention should the RN implement the evening before the scheduled ECT?

• A. Hold all bedtime medications.
• B. Keep the client NPO after midnight.
• C. Implement elopement precautions.
• D. Give the client an enema at bedtime.

Correct answer: B

Rationale: Keeping the client NPO after midnight is the appropriate intervention before ECT to prevent complications during the procedure. Withholding food and fluids reduces the risk of aspiration and helps ensure the safety of the client. Option A (Hold all bedtime medications) is incorrect because medications may need to be given as prescribed unless specified otherwise by the healthcare provider. Option C (Implement elopement precautions) is unrelated to preparing a client for ECT and focuses on preventing a client from leaving the treatment area. Option D (Give the client an enema at bedtime) is unnecessary and not a standard pre-ECT preparation, making it an incorrect choice.

2. A client with anorexia nervosa has a body mass index (BMI) of 16.5 and has been diagnosed with bradycardia. Which of the following findings should the RN be most concerned about?

• A. Body temperature of 96.8°F.
• B. Heart rate of 52 BPM.
• C. Serum potassium level of 4.1 mEq/L.
• D. Electrocardiogram (ECG) changes.

Correct answer: D

Rationale: In a client with anorexia nervosa and bradycardia, monitoring for ECG changes is crucial as these changes may indicate potentially life-threatening cardiac complications. While other findings like low body temperature, bradycardia, and serum potassium levels are concerning, ECG changes specifically reflect the impact of bradycardia on the heart's electrical activity and should be the priority for the nurse to assess and address.

3. A male client with bipolar disorder who began taking lithium carbonate five days ago is complaining of excessive thirst, and the nurse finds him attempting to drink water from the bathroom sink faucet. Which intervention should the nurse implement?

• A. Report the client’s serum lithium level to the healthcare provider.
• B. Encourage the client to suck on hard candy to relieve the symptoms.
• C. No action is needed since polydipsia is a common side effect.
• D. Tell the client that drinking from the faucet is not allowed.

Correct answer: B

Rationale: Encouraging the client to suck on hard candy is the appropriate intervention as it can help alleviate the sensation of excessive thirst, which is a common side effect of lithium. Reporting the client’s serum lithium level to the healthcare provider may be needed if there are signs of lithium toxicity, but the priority here is to address the immediate symptom of excessive thirst. Polydipsia, or excessive thirst, is a known side effect of lithium, but it should not be left unaddressed. Simply telling the client that drinking from the faucet is not allowed does not address the underlying issue of excessive thirst and may lead to further distress.

4. A client with obsessive-compulsive disorder (OCD) is undergoing behavioral therapy. Which outcome should the nurse recognize as an indication that the client is responding positively to therapy?

• A. The client reports increased frequency of obsessive thoughts.
• B. The client demonstrates a decrease in compulsive behaviors.
• C. The client expresses a desire to leave therapy early.
• D. The client avoids participating in exposure tasks.

Correct answer: B

Rationale: A decrease in compulsive behaviors is a positive response to behavioral therapy for OCD. Behavioral therapy aims to reduce these behaviors and promote healthier coping mechanisms. Option A, reporting an increased frequency of obsessive thoughts, would indicate a lack of improvement or worsening of symptoms. Option C, expressing a desire to leave therapy early, suggests resistance or dissatisfaction with therapy. Option D, avoiding participation in exposure tasks, goes against the principles of exposure therapy, which is commonly used in OCD treatment to help clients confront their fears and reduce anxiety.

5. What principle about patient-nurse communication should guide a nurse's fear of 'saying the wrong thing' to a patient?

• A. Patients tend to appreciate a well-meaning person who conveys genuine acceptance, respect, and concern for their situation.
• B. The patient is more interested in talking to you than listening to what you have to say and is not likely to be offended.
• C. Considering the patient's history, there is little chance that the comment will do any actual harm.
• D. Most people with a mental illness have by necessity developed a high tolerance for forgiveness.

Correct answer: A

Rationale: The correct principle guiding nurse-patient communication is that patients value genuine acceptance, respect, and concern. Choice A is the correct answer because showing genuine care and concern for the patient's situation fosters a positive and therapeutic relationship. Choice B is incorrect as effective communication involves active listening and responding appropriately, not assuming the patient is only interested in talking. Choice C is incorrect because a patient's history does not guarantee immunity to harm from inappropriate comments. Choice D is incorrect as it generalizes individuals with mental illness and forgiveness, which is not directly related to communication fears.

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