Nursing Elites

1. A client has been taking lithium for several years with good symptom control. The client presents in the emergency department with blurred vision, tinnitus, and severe diarrhea. Which lithium level should the nurse correlate with these symptoms?

• A. 3.7
• B. 1.7
• C. 2.6
• D. 1.3

Correct answer: B

Rationale: Symptoms such as blurred vision, tinnitus, and severe diarrhea are indicative of lithium toxicity. A lithium level of 1.7 is within the toxic range. When clients present with these symptoms, it is crucial for the nurse to correlate them with elevated lithium levels to ensure timely intervention and prevent further complications.

2. Which of the following statements about the DSM-5 is inaccurate?

• A. It includes specific criteria for diagnosing mental disorders.
• B. It is used by mental health professionals to guide diagnosis.
• C. It provides a classification system for mental disorders.
• D. It includes guidelines for the treatment of mental disorders.

Correct answer: D

Rationale: The DSM-5 is a diagnostic tool that provides specific criteria for diagnosing mental disorders, is utilized by mental health professionals to guide diagnosis, and offers a systematic classification of mental disorders. The statement that the DSM-5 includes guidelines for the treatment of mental disorders is inaccurate. The primary focus of the DSM-5 is on diagnosis and classification, not treatment. Therefore, choice D is the correct answer. Choices A, B, and C accurately describe the purpose and functions of the DSM-5.

3. When planning care for a client with schizophrenia, which of the following interventions should be included in the plan of care?

• A. Encourage reality testing
• B. Provide opportunities for socialization
• C. Monitor for command hallucinations
• D. Promote adherence to medication regimen

Correct answer: A

Rationale: When caring for a client with schizophrenia, encouraging reality testing is essential. This intervention assists the client in distinguishing between delusions and reality, aiding in their treatment. While providing opportunities for socialization can help reduce isolation, monitoring for command hallucinations is crucial for the client's safety. Promoting adherence to the medication regimen is vital for symptom management. Addressing delusional thoughts in a therapeutic manner is preferable to outright discouragement, fostering a supportive environment for the client.

4. Which intervention should the nurse implement when caring for a patient demonstrating manic behavior? Select one that doesn't apply.

• A. Monitor the patient's vital signs frequently.
• B. Keep the patient distracted with group-oriented activities.
• C. Provide the patient with frequent milkshakes and protein drinks.
• D. Reduce the volume on the television and dim bright lights in the environment.

Correct answer: B

Rationale: When caring for a patient demonstrating manic behavior, it is crucial to monitor vital signs frequently to ensure the patient's physical health is stable. Providing nutrition, such as milkshakes and protein drinks, is essential to meet the patient's dietary needs. Diminishing environmental stimuli by reducing the volume on the television and dimming bright lights can help create a calmer environment. However, keeping the patient distracted with group-oriented activities may not be the most appropriate intervention as it could potentially exacerbate the manic behavior by overstimulating the patient. Therefore, this choice is the one that doesn't apply in managing manic behavior effectively.

5. A patient with obsessive-compulsive disorder (OCD) is performing a ritualistic handwashing routine. What is the nurse's best initial response?

• A. Interrupt the ritual to help the patient gain control.
• B. Allow the ritual but set limits on the duration.
• C. Ignore the behavior to avoid reinforcing it.
• D. Encourage the patient to stop the ritual and discuss their feelings.

Correct answer: B

Rationale: In managing a patient with OCD engaging in ritualistic behaviors like handwashing, the nurse's best initial response is to allow the ritual but set limits on the duration. This approach helps in managing the behavior while gradually working towards reducing its frequency. Interrupting the ritual abruptly may cause distress to the patient, ignoring the behavior may reinforce it, and encouraging the patient to stop the ritual without setting limits may not be as effective in the initial stage of intervention.

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