Nursing Elites

1. Which behavior best indicates that the client has received adequate preparation for the scheduled diagnostic studies?

• A. Asks for the tests to be explained again
• B. Checks the appointment card multiple times
• C. Arrives early and waits quietly to be called for the tests
• D. Paces back and forth in the hallway on the morning of the tests

Correct answer: C

Rationale: The correct answer is arriving early and waiting quietly to be called for the tests. This behavior indicates that the client is prepared, as early arrival suggests an expected degree of anxiety and the quiet waiting indicates a lower level of anxiety and adequate preparation. Asking for the tests to be explained again may signal inadequate explanation, nervousness, or poor memory. Checking the appointment card repeatedly or pacing up and down the hallway indicate a high level of anxiety, which could be associated with inadequate teaching. Nurses providing preprocedural teaching should assess for anxiety related to procedures, coping mechanisms, and retention of information post-teaching. If issues are identified, strategies such as paraphrasing information, having a support person present, seeking advice from someone who has undergone the procedure, or visiting the test center beforehand can be utilized.

2. Jerry is a 55-year-old veteran who has been admitted after a motor vehicle accident with multiple injuries. His friend reported that he had been using synthetic marijuana prior to the accident, and that he also sees a psychiatrist at the VA hospital for an unknown diagnosis. He stated that Jerry sometimes gets "hyper"? for no reason, starts "ranting"? and becomes violent. Of the following, which general psychiatric disorder is characterized by a pattern of aggression or violence that includes irritability, agitation, and violent behavior during manic or psychotic episodes?

• A. Schizophrenia
• B. Post-traumatic stress disorder (PTSD)
• C. Bipolar disorder
• D. Delusional disorder

Correct answer: C

Rationale: Bipolar disorder is characterized by a pattern of aggression or violence that includes irritability, agitation, and violent behavior during manic or psychotic episodes. This disorder is highly co-morbid with substance use, which can worsen the prognosis. While schizophrenia may involve aggression, it is not typically associated with mood episodes like mania that characterize bipolar disorder. Post-traumatic stress disorder (PTSD) is primarily characterized by re-experiencing traumatic events, avoidance behaviors, and hyperarousal, but not the distinct mood episodes seen in bipolar disorder. Delusional disorder is characterized by fixed false beliefs without the mood changes seen in bipolar disorder. Therefore, the correct answer is Bipolar disorder.

3. Which of the following mental health situations is considered a psychiatric emergency?

• A. Seasonal Affective Disorder (SAD)
• B. Depression with melancholic features
• C. Major depressive episode with psychotic features
• D. Bipolar depression

Correct answer: C

Rationale: A major depressive episode with psychotic features is considered a psychiatric emergency because it poses a significant risk to the individual's safety. Psychotic features in depression can include hallucinations, delusions, or other severe symptoms that require immediate intervention. While Seasonal Affective Disorder (SAD) and depression with melancholic features are serious conditions, they do not inherently represent an acute emergency that necessitates immediate hospitalization. Bipolar depression, although severe, does not inherently involve psychotic symptoms that would classify it as a psychiatric emergency requiring immediate intervention. It's crucial to recognize the urgency and severity of major depressive episodes with psychotic features to ensure appropriate and timely treatment.

4. Ten minutes after signing an operative permit for a fractured hip, an older client states, 'The aliens will be coming to get me soon!' and falls asleep. Which action should the nurse implement next?

• A. Make the client comfortable and allow the client to sleep.
• B. Assess the client's neurologic status.
• C. Notify the surgeon about the comment.
• D. Ask the client's family to co-sign the operative permit.

Correct answer: B

Rationale: The client's statement about aliens coming to get them could indicate confusion, which raises concerns about their neurologic status. Since informed consent for surgery requires the client to be mentally competent, the nurse should assess the client's neurologic status to ensure they understand and can legally provide consent. Option A of making the client comfortable and letting them sleep does not address the potential neurologic issue. If the nurse finds the client to be confused, it is essential to inform the surgeon and seek permission from the next of kin if necessary. Therefore, assessing the client's neurologic status is the priority to ensure the client's ability to consent to the surgery.

5. A nurse is assigned to care for a close friend in the hospital setting. Which action should the nurse take first when given the assignment?

• A. Notify the friend that all medical information will be kept confidential.
• B. Explain the relationship to the charge nurse and ask for reassignment.
• C. Approach the client and ask if the assignment is uncomfortable.
• D. Accept the assignment but protect the client's confidentiality.

Correct answer: B

Rationale: When a nurse is assigned to care for a close friend, it is essential to maintain professional boundaries to ensure the best care for the client and the nurse. The most appropriate action for the nurse to take first is to explain the relationship to the charge nurse and ask for reassignment (B). This is important to avoid potential conflicts of interest and maintain objectivity in the care provided. Option A, notifying the friend about confidentiality, may not address the underlying issue of the conflict of interest. Option C, asking the client if the assignment is uncomfortable, may not be appropriate as it puts the client in a difficult position. Option D, accepting the assignment but protecting the client's confidentiality, does not address the conflict of interest and potential ethical issues that may arise from caring for a close friend.

Similar Questions