Nursing Elites

1. A client is admitted to the psychiatric unit with a diagnosis of bipolar disorder, manic phase. Which activity is most appropriate for the LPN/LVN to suggest to the client?

• A. Playing a game of basketball with other clients.
• B. Taking a walk with the nurse in the garden.
• C. Working on a puzzle in a quiet room.
• D. Writing in a journal.

Correct answer: C

Rationale: During the manic phase of bipolar disorder, individuals may experience heightened levels of energy and agitation. Engaging in activities that are overly stimulating, such as playing basketball with others (choice A) or taking a walk in a garden (choice B), can exacerbate these symptoms. Writing in a journal (choice D) may also be too stimulating and may not provide the necessary distraction. Working on a puzzle in a quiet room (choice C) can offer a calming and focused activity that helps reduce anxiety and channel excess energy into a structured task, making it the most appropriate choice for a client in the manic phase of bipolar disorder.

2. A client with a history of bipolar disorder presents to the emergency department with symptoms of mania. What is the priority nursing intervention?

• A. Administer prescribed medication to manage symptoms.
• B. Provide a calm environment with minimal stimulation.
• C. Encourage the client to express feelings and emotions.
• D. Reinforce the need for consistent medication adherence.

Correct answer: A

Rationale: Administering prescribed medication to manage symptoms is the priority intervention for a client with symptoms of mania. During a manic episode, the client may be at risk of harm to self or others due to impulsivity and poor judgment. Medication helps stabilize the client, reduce manic symptoms, and prevent further escalation. Providing a calm environment (choice B) is important but not the priority when the client's safety is at risk. Encouraging expression of feelings (choice C) and reinforcing medication adherence (choice D) are valuable aspects of care but addressing the acute symptoms of mania takes precedence to ensure the client's immediate safety and well-being.

3. A client in the manic phase of bipolar disorder is pacing the hallway and talking rapidly. What is the best intervention for the nurse?

• A. Encourage the client to join a group activity.
• B. Offer the client a high-calorie snack and a drink.
• C. Direct the client to a quieter area of the unit.
• D. Instruct the client to sit down and relax.

Correct answer: B

Rationale: In the manic phase of bipolar disorder, clients often exhibit increased activity and may burn a lot of energy. Offering a high-calorie snack and a drink is the best intervention as it helps maintain their nutritional needs while allowing them to continue their activity. Encouraging the client to join a group activity (Choice A) may further stimulate their behavior. Directing the client to a quieter area (Choice C) might not address their energy expenditure. Instructing the client to sit down and relax (Choice D) may not be effective during the manic phase.

4. When caring for a client with borderline personality disorder, what is the most effective nursing intervention?

• A. Set clear and consistent boundaries for the client.
• B. Allow the client to vent their feelings without interruption.
• C. Encourage the client to participate in group therapy.
• D. Provide the client with frequent reassurance and support.

Correct answer: A

Rationale: Setting clear and consistent boundaries is essential when caring for a client with borderline personality disorder. This intervention helps provide structure, maintain a therapeutic relationship, and prevent manipulative behaviors. Allowing the client to vent feelings without interruption (Choice B) may not address the underlying issues effectively. Encouraging participation in group therapy (Choice C) can be beneficial but setting boundaries is more crucial. Providing frequent reassurance and support (Choice D) may inadvertently reinforce maladaptive behaviors instead of promoting growth and independence.

5. When a client with schizophrenia is being discharged on antipsychotic medication, what is the most important instruction the nurse should provide?

• A. Stop the medication if you start feeling better.
• B. Be aware of the potential for weight gain with this medication.
• C. Report any unusual muscle movements immediately.
• D. You can drive as soon as you feel ready.

Correct answer: C

Rationale: The correct answer is to instruct the client to report any unusual muscle movements immediately. These movements may indicate extrapyramidal symptoms (EPS) or tardive dyskinesia, which are serious side effects of antipsychotic medications that require immediate attention. Choice A is incorrect because stopping the medication without medical advice can lead to a relapse of symptoms. Choice B is important but not as critical as monitoring for EPS. Choice D is incorrect because driving readiness is not directly related to antipsychotic medication instructions.

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