Nursing Elites

1. Tomas is a 21-year-old male with a recent diagnosis of schizophrenia. Tomas's nurse recognizes that self-medicating with excessive alcohol is common in this disease and can co-occur along with:

• A. Generally good health despite the mental illness.
• B. An aversion to drinking fluids.
• C. Anxiety and depression.
• D. The ability to express his needs.

Correct answer: C

Rationale: Individuals with schizophrenia often turn to excessive alcohol consumption as a way to manage symptoms of anxiety and depression. This maladaptive coping mechanism can exacerbate the challenges associated with schizophrenia and may hinder effective treatment outcomes. Recognizing the presence of anxiety and depression alongside alcohol abuse is crucial for providing holistic care and support to individuals with schizophrenia.

2. 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.

3. After a client with major depressive disorder undergoes electroconvulsive therapy (ECT), which of the following is a priority assessment for the nurse?

• A. Monitoring for signs of infection
• B. Monitoring for signs of respiratory distress
• C. Monitoring for signs of hypotension
• D. Monitoring for signs of bleeding

Correct answer: B

Rationale: The priority assessment for the nurse after a client undergoes electroconvulsive therapy (ECT) is monitoring for signs of respiratory distress. This is crucial due to the potential risk of complications from anesthesia, such as airway compromise or respiratory depression. Prompt identification and intervention in case of respiratory distress are essential to ensure the client's safety and well-being. Monitoring for signs of infection (Choice A) is important but not the priority immediately post-ECT. Hypotension (Choice C) and bleeding (Choice D) are also potential concerns but assessing respiratory distress takes precedence due to the immediate risk it poses to the client's well-being.

4. A client is prescribed diazepam (Valium) for anxiety. Which statement by the client indicates a need for further teaching?

• A. I can drink alcohol while taking this medication.
• B. I should avoid drinking alcohol while taking this medication.
• C. I should take this medication only when I feel anxious.
• D. I can stop taking this medication when I feel better.

Correct answer: A

Rationale: The correct answer is A because clients should avoid alcohol while taking diazepam (Valium) due to potential interactions. Alcohol can increase the sedative effects of diazepam, leading to excessive drowsiness or respiratory depression. Choice B is correct as it reflects the need to avoid alcohol. Choice C is incorrect because diazepam is usually taken regularly, not just when feeling anxious. Choice D is incorrect as abruptly stopping diazepam can lead to withdrawal symptoms and should be done gradually under medical supervision.

5. A client with generalized anxiety disorder (GAD) is being discharged. Which of the following instructions should the nurse include in the discharge teaching? Select one that does not apply.

• A. Practice relaxation techniques daily
• B. Avoid caffeine and alcohol
• C. Engage in regular physical activity
• D. Use benzodiazepines as the first line of treatment

Correct answer: D

Rationale: When discharging a client with GAD, it is important to provide instructions that promote holistic well-being and support without exacerbating the condition. Practicing relaxation techniques daily, avoiding caffeine and alcohol, and engaging in regular physical activity can help manage anxiety symptoms effectively. These strategies focus on self-care and healthy lifestyle choices. Seeking support from friends and family also plays a crucial role in maintaining mental health. However, using benzodiazepines as the first line of treatment is not recommended due to their potential for dependence and other associated risks. Non-pharmacological interventions and therapy are usually preferred as initial approaches in managing GAD. Therefore, the option 'D: Use benzodiazepines as the first line of treatment' is incorrect and should not be included in the discharge teaching for a client with GAD.

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