Nursing Elites

1. A client with depression remains in bed most of the day and declines activities. Which nursing problem has the greatest priority for this client?

• A. Loss of interest in diversional activity.
• B. Social isolation.
• C. Refusal to address nutritional needs.
• D. Low self-esteem.

Correct answer: C

Rationale: The correct answer is C: 'Refusal to address nutritional needs.' When a client with depression remains in bed and declines activities, addressing their refusal to address nutritional needs is of utmost priority. Nutritional needs are essential for physical health and overall well-being. Inadequate nutrition can worsen the client's physical health, impact their mood, and hinder the effectiveness of treatment. Option A, 'Loss of interest in diversional activity,' while important, is not as critical as addressing nutritional needs for immediate physical well-being. Option B, 'Social isolation,' is a significant concern but addressing nutritional needs takes precedence due to its direct impact on physical health. Option D, 'Low self-esteem,' is a valid concern but does not take priority over addressing the client's refusal to meet their nutritional needs for immediate health benefits.

2. A client with a diagnosis of schizophrenia is exhibiting negative symptoms such as anhedonia and social withdrawal. Which intervention should be a priority for the nurse?

• A. Encourage participation in group activities.
• B. Administer prescribed antipsychotic medication.
• C. Assist the client in setting realistic goals.
• D. Promote engagement in social interactions.

Correct answer: A

Rationale: Encouraging participation in group activities is a priority intervention for a client with schizophrenia exhibiting negative symptoms like anhedonia and social withdrawal. Group activities provide structured social interactions and can help the client gradually re-engage with others, potentially reducing social withdrawal and improving social skills. Administering antipsychotic medication (Choice B) is essential in managing positive symptoms of schizophrenia such as hallucinations and delusions, not negative symptoms like anhedonia and social withdrawal. While assisting the client in setting realistic goals (Choice C) is important for overall care, addressing social withdrawal and anhedonia is more immediate. Promoting engagement in social interactions (Choice D) is beneficial, but encouraging participation in group activities provides a structured and supportive environment that can specifically target the negative symptoms being exhibited.

3. The RN is providing education about strategies for a safety plan for a female client who is a victim of intimate partner violence. Which strategies should be included in the safety plan? (SOA)

• A. Purchase a gun for protection.
• B. Establish a code with family and friends to signal violence.
• C. Take a self-defense course focused on protection.
• D. Prepare a bag with extra clothes for self and children.

Correct answer: B

Rationale: Establishing a code with family and friends is crucial in situations of intimate partner violence as it allows discreet communication for help without alerting the abuser. Having a pre-prepared bag with essentials like extra clothes is important to facilitate a quick exit if necessary. Purchasing a gun is not a recommended safety strategy as it can escalate violence and pose more danger. While taking a self-defense course focused on protection is beneficial, it is essential to avoid courses that emphasize retaliation, as they can increase the risk and escalate violence.

4. 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.

5. A male veteran who recently returned from a war zone has post-traumatic stress disorder (PTSD) and is admitted to the psychiatric ward due to admitted suicidal ideation. On admission, the client’s family informed the healthcare provider that therapy sessions did not seem to be helping. Select only one intervention that has the highest priority.

• A. Administer paroxetine 40 mg as prescribed.
• B. Develop a list of therapy programs.
• C. Remove all shaving equipment.
• D. Determine if the client has a suicide plan.

Correct answer: C

Rationale: The highest priority intervention in this scenario is to ensure the safety of the client who is admitted due to suicidal ideation. Removing all shaving equipment is crucial to prevent self-harm or suicide attempts using sharp objects. Administering medication or developing a list of therapy programs can be important but ensuring immediate safety takes precedence. Determining if the client has a suicide plan is also essential but not as urgent as removing potential means for self-harm.

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