Nursing Elites

1. A client, who is on a 30-day commitment to a drug rehabilitation unit, asks the nurse if he can go for a walk on the grounds of the treatment center. When he is told that his privileges do not include walking on the grounds, the client becomes verbally abusive. Which approach will the nurse take?

• A. Call a staff member to escort the client to his room.
• B. Tell the client to talk to his healthcare provider about his privileges.
• C. Remind the client of the unit rules.
• D. Ignore the client's inappropriate behavior.

Correct answer: C

Rationale: (C) is the correct approach in this situation as it reinforces unit rules, setting clear boundaries and expectations. By reminding the client of the unit rules, the nurse is helping to maintain a safe and structured environment within the drug rehabilitation unit. (A) is unnecessary since the client's behavior does not warrant immediate physical intervention. (B) is not ideal because the client's privileges have already been explained, and suggesting he speak to his healthcare provider may not address the immediate issue. (D) is not appropriate as addressing inappropriate behavior is essential in a therapeutic setting.

2. A nurse is providing discharge teaching to a client with schizophrenia who is prescribed clozapine (Clozaril). Which information should the nurse include?

• A. You need to come in for regular blood tests.
• B. This medication can cause weight loss.
• C. You can stop taking this medication once you feel better.
• D. Avoid foods high in tyramine while on this medication.

Correct answer: A

Rationale: The correct answer is A: 'You need to come in for regular blood tests.' Clozapine can cause agranulocytosis, a potentially life-threatening condition, so regular blood tests are required to monitor the client's white blood cell count. Choice B is incorrect because clozapine is associated with weight gain, not weight loss. Choice C is incorrect because the client should never stop taking clozapine abruptly due to the risk of withdrawal symptoms and symptom relapse. Choice D is incorrect because avoiding foods high in tyramine is typically associated with MAOIs, not clozapine.

3. A client is admitted to a medical nursing unit with a diagnosis of acute blindness. Many tests are performed, and there seems to be no organic reason why this client cannot see. The client became blind after witnessing a hit-and-run car accident, when a family of three was killed. A LPN/LVN suspects that the client may be experiencing a:

• A. Psychosis
• B. Repression
• C. Conversion Disorder
• D. Dissociative Disorder

Correct answer: C

Rationale: In this scenario, the client's acute blindness without any organic cause following a traumatic event indicates a case of Conversion Disorder. Conversion Disorder involves the manifestation of physical symptoms due to psychological stressors. Psychosis (choice A) involves a loss of contact with reality, which is not evident here. Repression (choice B) is a defense mechanism that involves unconsciously blocking out thoughts. Dissociative Disorder (choice D) involves disruptions in memory, awareness, identity, or perception, which is not the primary issue in this case.

4. A female client with severe depression who has been on antidepressants for two weeks suddenly becomes more energetic and talkative. What action should the RN take first?

• A. Encourage the client to participate in group activities.
• B. Monitor the client closely for signs of suicidal behavior.
• C. Praise the client for the apparent improvement.
• D. Discuss the client's progress with the healthcare provider.

Correct answer: B

Rationale: A sudden increase in energy and talkativeness in a client with severe depression who has been on antidepressants for a short period may indicate an increased risk of suicide due to the potential shift from profound sadness to motivation to act. The first action the RN should take is to monitor the client closely for signs of suicidal behavior. Encouraging participation in group activities or praising the client for the apparent improvement may overlook the potential risk of suicidal behavior. While discussing the client's progress with the healthcare provider is important, the immediate concern is to ensure the client's safety by closely monitoring for any signs of suicidal ideation or behavior.

5. 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.

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