Nursing Elites

1. Which factors tend to increase the difficulty of diagnosing young children who demonstrate behaviors associated with mental illness? Select all that apply.

• A. Limited language skills
• B. Level of cognitive development
• C. Level of emotional development
• D. Parental denial that a problem exists

Correct answer: B

Rationale: The correct answer is B: Level of cognitive development. The level of cognitive development is a crucial factor that can complicate the diagnosis of mental illness in young children. Young children may not have fully developed cognitive abilities to express their symptoms or understand diagnostic procedures, making it challenging for healthcare providers to assess their mental health accurately. Limited language skills (choice A) can hinder communication but are not as significant as cognitive development in diagnosing mental illness. Emotional development (choice C) is important but may not be as directly linked to the diagnostic challenges as cognitive development. Parental denial (choice D), although a potential barrier, is not a factor inherent to the child's characteristics affecting the diagnostic process.

2. A client with a history of bipolar disorder is exhibiting symptoms of mania. Which intervention is most appropriate for the nurse to implement?

• A. Encourage the client to participate in group therapy.
• B. Provide a calm and structured environment.
• C. Limit stimulation and set firm limits on behavior.
• D. Promote self-care and hygiene practices.

Correct answer: C

Rationale: When a client with bipolar disorder is experiencing symptoms of mania, the most appropriate intervention for the nurse is to limit stimulation and set firm limits on behavior. This approach helps in managing the manic episode by preventing further escalation. Encouraging participation in group therapy (Choice A) may not be effective during the acute phase of mania, as the client may have difficulty focusing or following group discussions. Providing a calm and structured environment (Choice B) is beneficial, but setting firm limits is crucial to managing the impulsivity and risky behaviors associated with mania. Promoting self-care practices (Choice D) is important, but during a manic episode, setting limits and reducing stimuli take precedence over hygiene practices.

3. A client with major depressive disorder is beginning a new antidepressant medication. Which instruction should the nurse include in the discharge teaching?

• A. “It may take several weeks to notice improvement.”
• B. “You should see immediate effects of the medication.”
• C. “You can stop taking the medication once you feel better.”
• D. “Avoid discussing your symptoms with your therapist.”

Correct answer: A

Rationale: The correct instruction the nurse should include in the discharge teaching for a client starting a new antidepressant medication is that “It may take several weeks to notice improvement.” This is because antidepressants often require several weeks before the individual starts to feel the full therapeutic effects. Choice B is incorrect because immediate effects are not typically seen with antidepressants. Choice C is incorrect as stopping the medication abruptly can lead to worsening symptoms or withdrawal effects. Choice D is incorrect as open communication with the therapist is crucial for effective management of major depressive disorder.

4. An older male client with schizophrenia is found smearing feces on the bathroom walls of the chronic mental health unit where he resides. What action should the RN implement?

• A. Explain that the feces belong in the toilet.
• B. Show the client how to clean the walls.
• C. Escort the client out of the bathroom.
• D. Assist the client to clean the walls.

Correct answer: C

Rationale: Escorting the client out of the bathroom is the most appropriate action to take in this situation. This helps prevent further inappropriate behavior and maintains hygiene, while avoiding reinforcement of the behavior. Option A, explaining that the feces belong in the toilet, may not be effective as the behavior is likely a manifestation of the client's condition rather than a lack of understanding. Option B, showing the client how to clean the walls, may not address the underlying issue and could potentially reinforce the behavior. Option D, assisting the client to clean the walls, may also reinforce the behavior and is not the best approach to managing the situation.

5. An elderly client diagnosed with delirium is being treated with antipsychotic medication. Which side effect should the nurse monitor for in this client?

• A. Akathisia
• B. Hallucinations
• C. Orthostatic hypotension
• D. Drowsiness

Correct answer: C

Rationale: The correct side effect that the nurse should monitor for in an elderly client diagnosed with delirium and treated with antipsychotic medication is orthostatic hypotension. Antipsychotic medications can lead to a drop in blood pressure upon standing, particularly in elderly individuals. Akathisia (choice A) refers to a movement disorder characterized by a feeling of inner restlessness and a compelling need to be in constant motion, which can be a side effect of antipsychotic medications but is not specific to elderly clients with delirium. Hallucinations (choice B) are sensory perceptions that appear real but are created by the mind, and while they can be associated with certain conditions or medications, they are not a common side effect of antipsychotic medications in elderly clients with delirium. Drowsiness (choice D) is a general CNS depressant effect that can occur with antipsychotic medications but is not the specific side effect that the nurse should be monitoring for in this case.

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