Nursing Elites

1. A client with Alzheimer's disease is becoming increasingly agitated and combative in the late afternoon. What is the most appropriate intervention?

• A. Offer a sedative medication to calm the client.
• B. Encourage the client to rest in a quiet, low-stimulation environment.
• C. Use reality orientation to reduce confusion.
• D. Engage the client in physical activity to reduce agitation.

Correct answer: B

Rationale: Encouraging the client to rest in a quiet, low-stimulation environment is the most appropriate intervention for a client with Alzheimer's disease who is becoming agitated and combative in the late afternoon. This approach helps reduce agitation and prevent overstimulation, providing a calming and soothing environment for the client. Offering a sedative medication (Choice A) should be avoided as it may have side effects and should only be considered as a last resort. Reality orientation (Choice C) may increase confusion and distress in clients with advanced Alzheimer's disease. Engaging the client in physical activity (Choice D) could potentially escalate the agitation rather than reduce it in this scenario.

2. A client with bipolar disorder is prescribed valproic acid (Depakote). What is the most important laboratory test for the LPN/LVN to monitor?

• A. Liver function tests.
• B. Kidney function tests.
• C. Thyroid function tests.
• D. Complete blood count.

Correct answer: A

Rationale: The correct answer is A: Liver function tests. Monitoring liver function tests is crucial for clients prescribed valproic acid (Depakote) due to the medication's potential to affect liver function and increase the risk of liver toxicity. While kidney function tests (choice B), thyroid function tests (choice C), and complete blood count (choice D) are important in various clinical scenarios, the priority when administering valproic acid is to monitor liver function to prevent adverse effects associated with this medication.

3. A client with depression is prescribed an SSRI. The client asks, 'Why do I need to take this medication every day?' What is the best response by the nurse?

• A. This medication will help balance the chemicals in your brain.
• B. This medication needs to be taken regularly to be effective.
• C. This medication will start working immediately to improve your mood.
• D. You should take this medication only when you feel sad or depressed.

Correct answer: D

Rationale: Explaining that the medication may take several weeks to take full effect helps manage the client's expectations and encourages adherence to the prescribed treatment.

4. A nurse is providing discharge teaching to a client with major depressive disorder who is prescribed fluoxetine (Prozac). What is the most important teaching point for the nurse to include?

• A. You may experience dizziness, so avoid driving.
• B. It may take several weeks to feel the full effect of the medication.
• C. Avoid foods high in tyramine while taking this medication.
• D. Take this medication only when you feel depressed.

Correct answer: B

Rationale: The correct answer is B because SSRIs like fluoxetine typically take several weeks to reach their full therapeutic effect, so it's important to set realistic expectations for the client. Choice A is incorrect as dizziness is a common side effect but not the most important teaching point. Choice C is incorrect as avoiding tyramine-rich foods is more relevant for MAOIs. Choice D is incorrect as fluoxetine should be taken consistently, not only when the client feels depressed, to maintain therapeutic blood levels.

5. A male client with schizophrenia tells the nurse that the FBI is monitoring his phone calls. What is the nurse's best response?

• A. Let's talk about your feelings of being monitored.
• B. There is no evidence that the FBI is monitoring your calls.
• C. Why do you think the FBI is interested in your phone calls?
• D. I can assure you that your phone calls are not being monitored.

Correct answer: A

Rationale: The correct response is to choose A: 'Let's talk about your feelings of being monitored.' This response shows empathy and encourages the client to express his feelings. Engaging the client in a discussion about his feelings can help address underlying fears without directly challenging the delusion. Choice B is incorrect because directly denying the delusion may lead to increased distrust or agitation in the client. Choice C may come across as confrontational, which can exacerbate the client's paranoia. Choice D offers a false sense of assurance and does not address the client's concerns effectively.

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