Nursing Elites

1. A client on the mental health unit is becoming more agitated, shouting at the staff, and pacing in the hallway. When a PRN medication is offered, the client refuses the medication and defiantly sits on the floor in the middle of the unit hallway. What nursing intervention should the nurse implement first?

• A. Transport the client to the seclusion room.
• B. Quietly approach the client with additional staff members.
• C. Take other clients in the area to the client lounge.
• D. Administer medication to chemically restrain the client.

Correct answer: B

Rationale: In situations where a client is agitated and refusing medication, a non-confrontational approach with additional staff can help de-escalate the situation and address the client's behavior safely. Transporting the client to the seclusion room (Choice A) should not be the initial intervention unless the client poses an immediate risk of harm to themselves or others. Taking other clients to the client lounge (Choice C) does not directly address the agitated client's behavior. Administering medication to chemically restrain the client (Choice D) should only be considered after other de-escalation attempts have been made and if there is a significant safety concern.

2. After receiving treatment for anorexia, a student asks the school nurse for permission to work in the school cafeteria as part of the school’s work-study program. What action should the nurse take?

• A. Recommend assignment to the receptionist's office.
• B. Suggest that the student work in the athletic department.
• C. Refer the student to a psychiatrist for further discussion.
• D. Determine the parents' opinion of the work assignment.

Correct answer: A

Rationale: Clients with anorexia are often fixated on food and exercise, which can exacerbate their condition. By recommending assignment to the receptionist's office, the nurse provides an environment that minimizes exposure to food-related triggers. Working in the cafeteria may intensify the student's preoccupation with food, making it an unsuitable choice. Referring the student to a psychiatrist without exploring less triggering work options first may not be necessary. Determining the parents' opinion is important, but in this context, the focus should be on selecting a work environment that supports the student's recovery.

3. A client with major depressive disorder is prescribed lithium carbonate. Which finding should the RN report to the healthcare provider?

• A. Serum lithium level of 0.8 mEq/L
• B. Blood urea nitrogen (BUN) level of 16 mg/dL
• C. Serum sodium level of 138 mEq/L
• D. Urine output of 800 mL in 24 hours

Correct answer: B

Rationale: The correct answer is B. Elevated BUN levels may indicate renal impairment, which is crucial to report for clients on lithium due to its potential kidney effects. Option A, a serum lithium level of 0.8 mEq/L, is within the therapeutic range for lithium and does not require immediate reporting. Option C, a serum sodium level of 138 mEq/L, is within the normal range and not directly related to lithium therapy. Option D, urine output of 800 mL in 24 hours, may indicate a need for further assessment but is not the most critical finding to report compared to potential renal impairment indicated by an elevated BUN level.

4. The occupational health nurse is working with a female employee who was just notified that her child was involved in a motor vehicle accident (MVA) and taken to the hospital. The employee states, “I can’t believe this. What should I do?” Which response is best for the nurse to provide in this crisis?

• A. Tell me what you think should be done.
• B. How serious was the collision?
• C. What do you think you should do?
• D. Call for transportation to the hospital.

Correct answer: D

Rationale: In a crisis situation where the female employee's child is involved in a motor vehicle accident (MVA) and taken to the hospital, the most appropriate response for the nurse is to provide immediate practical assistance. Calling for transportation to the hospital ensures that the employee can quickly reach her child in need of urgent medical attention. The other options (A, B, and C) do not address the immediate need for assistance and may not provide the necessary support required in such a critical situation.

5. A healthcare professional is assessing a client for symptoms of post-traumatic stress disorder (PTSD). Which symptom should the healthcare professional expect to find?

• A. Persistent thoughts about the trauma.
• B. Increased energy and enthusiasm.
• C. Decreased need for sleep.
• D. Increased appetite and weight gain.

Correct answer: A

Rationale: The correct answer is A: Persistent thoughts about the trauma. In post-traumatic stress disorder (PTSD), individuals often experience persistent intrusive thoughts about the traumatic event, which can be distressing and disruptive. This symptom is a hallmark feature of PTSD. Choices B, C, and D are incorrect because increased energy, enthusiasm, decreased need for sleep, increased appetite, and weight gain are not typical symptoms of PTSD. Instead, individuals with PTSD may commonly experience symptoms such as flashbacks, nightmares, hypervigilance, avoidance of triggers related to the trauma, and negative changes in mood and cognition.

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