Nursing Elites

1. 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.

2. An RN is providing education to the family of a client diagnosed with schizophrenia who is being treated with clozapine (Clozaril). The RN should instruct the family to report which symptom immediately?

• A. Sore throat
• B. Weight loss
• C. Constipation
• D. Lightheadedness

Correct answer: A

Rationale: The correct answer is A: Sore throat. Clozapine can lead to agranulocytosis, a condition characterized by a significant decrease in white blood cells. A sore throat can be an early sign of agranulocytosis, a potentially life-threatening adverse effect of clozapine. The family should report this symptom immediately to the healthcare provider for further evaluation and management. Choices B, C, and D are incorrect because weight loss, constipation, and lightheadedness are not typically associated with the serious adverse effect of agranulocytosis related to clozapine therapy.

3. During the admission assessment of an underweight adolescent with depression on a psychiatric unit, the nurse finds a potassium level of 2.9 mEq/dl. Which finding requires notification to the healthcare provider?

• A. Potassium level of 2.9 mEq/dl.
• B. BP of 110/70 mmHg.
• C. WBC of 10,000 mm³.
• D. Body mass index of 21.

Correct answer: A

Rationale: A potassium level of 2.9 mEq/dl is critically low, indicating hypokalemia, which can lead to serious complications such as cardiac arrhythmias. Prompt notification to the healthcare provider is essential for immediate intervention. Choice B, a blood pressure of 110/70 mmHg, is within the normal range. Choice C, a white blood cell count of 10,000 mm³, is also within normal limits and is not a concerning finding in this context. Choice D, a body mass index of 21, may indicate being underweight but is not as urgent as addressing the critically low potassium level.

4. The client is preparing to discontinue the use of a sedative-hypnotic medication. Which instruction should the nurse include?

• A. “You may experience withdrawal symptoms; these are usually mild.”
• B. “The medication will need to be gradually tapered off.”
• C. “You should increase your caffeine intake to stay alert.”
• D. “There should be no change in your sleep patterns during discontinuation.”

Correct answer: B

Rationale: When discontinuing sedative-hypnotic medications, it is crucial to gradually taper them off to prevent withdrawal symptoms. Choice A is incorrect because withdrawal symptoms can be severe, not always mild. Choice C is incorrect as increasing caffeine intake can exacerbate sleep disturbances. Choice D is incorrect because changes in sleep patterns are expected during discontinuation of sedative-hypnotic medications.

5. A client is being educated by a nurse about strategies for a safety plan for intimate partner violence. Which strategies should be included in the safety plan? (Select all that apply)

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

Correct answer: A

Rationale: The correct strategies for a safety plan for a victim of intimate partner violence include having a bag ready with essentials for self and children and establishing a code with family and friends to signal danger. These strategies can help the client prepare for emergencies and seek help discreetly. Purchasing a gun (Choice C) is not a safe or recommended strategy as it can escalate violence and pose more significant risks. Additionally, taking a self-defense course focused on self-protection (Choice D) is important for self-defense, but it should not involve retaliatory actions against the abuser with the intent to cause harm.

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