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 schizophrenia is admitted to the psychiatric care unit for aggressive behavior, auditory hallucinations, and potential for self-harm. The client has not been taking medications as prescribed and insists that the food has been poisoned and refuses to eat. What intervention should the RN implement?

• A. Assure the client that all food served in the hospital is safe to eat.
• B. Tell the client that irrational thinking is a symptom of schizophrenia.
• C. Obtain an order for a tube feeding for the client.
• D. Provide the client with food in unopened containers.

Correct answer: D

Rationale: The correct intervention is to provide the client with food in unopened containers. This approach can help alleviate the client's fear of poisoning and encourage eating. Choice A may not address the client's specific fear and may be perceived as dismissive. Choice B, while providing information about symptoms of schizophrenia, does not address the immediate issue of the client's refusal to eat due to the fear of poisoning. Choice C of obtaining an order for tube feeding is premature and invasive before exploring less restrictive options.

3. In a mental health unit of a hospital, a LPN/LVN is leading a group psychotherapy session. What is the nurse's role in the termination stage of group development?

• A. Encourage problem solving
• B. Encourage accomplishment of the group's work
• C. Acknowledge the contributions of each group member
• D. Encourage members to become acquainted with one another

Correct answer: C

Rationale: During the termination stage of group development in psychotherapy, the nurse's role is to acknowledge the contributions of each group member. This action helps to close the group on a positive note, reinforcing the therapeutic experience. Choice A, encouraging problem-solving, is more relevant in the earlier stages of group development. Choice B, encouraging the accomplishment of the group's work, is important throughout the group process but is not specific to the termination stage. Choice D, encouraging members to become acquainted with one another, is more aligned with the initial stages of group formation rather than the termination stage.

4. A female client presents to the emergency center with confusion, emotional numbness, and expresses to the nurse a feeling of disbelief that she was raped. The nurse determines the client is in the acute phase of rape-trauma syndrome. What action should the nurse implement first?

• A. Secure samples of vaginal hair combings.
• B. Offer prophylactic antibiotic medication.
• C. Explain the rape protocol to the client.
• D. Implement crisis intervention counseling.

Correct answer: C

Rationale: In cases of rape-trauma syndrome, it is crucial to provide clear information about what to expect during the examination and treatment. This can help the client regain a sense of control and reduce anxiety. Explaining the rape protocol to the client should be the first action to implement. Option A is not the priority at this stage as the immediate focus is on addressing the client's emotional needs and providing support. Option B is not the first action unless medically indicated. Option D, crisis intervention counseling, is important but should come after providing essential information and support to the client.

5. 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.

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