Nursing Elites

1. What action is most important for the RN to implement within the first 24 hours after treatment is initiated for a homeless client who reports feeling sad and depressed and has only had 4 hours of sleep in the past 2 days?

• A. Allow the client to rest and sleep.
• B. Ensure the client attends groups addressing coping skills for dealing with depression.
• C. Begin planning for the client’s discharge.
• D. Encourage verbalization of feelings.

Correct answer: A

Rationale: A: Addressing the client’s immediate need for rest and sleep is crucial for stabilization and recovery. It is essential to prioritize the client's physical well-being and provide the opportunity for adequate rest. B: Group therapy and coping skills are important but secondary to ensuring immediate needs are met. C: Discharge planning is important but should follow stabilization of the client’s immediate needs. D: Encouraging verbalization of feelings is supportive but not as urgent as addressing basic needs like rest.

2. When developing a plan of care for a male client admitted with delirium tremens, who is dehydrated, experiencing auditory hallucinations, has a bruised, swollen tongue, and is confused, what action should the RN include to ensure the client is physiologically stable?

• A. Encourage oral fluids.
• B. Monitor vital signs.
• C. Keep the room dark.
• D. Apply ice to his tongue.

Correct answer: B

Rationale: Monitoring vital signs is the priority action to ensure the physiological stability of a client with delirium tremens. In this scenario, the client's dehydration, confusion, and other symptoms necessitate close monitoring of vital signs to assess their condition accurately. Encouraging oral fluids (Choice A) is important for hydration but does not directly assess physiological stability. Keeping the room dark (Choice C) may help with hallucinations but is not the primary intervention for physiological stability. Applying ice to the tongue (Choice D) addresses a symptom but is less critical compared to monitoring vital signs in this situation.

3. A healthcare professional is assessing a client for symptoms of post-traumatic stress disorder (PTSD). Which symptom should the healthcare professional expect to find?

• A. Persistent thoughts about the trauma.
• B. Increased energy and enthusiasm.
• C. Decreased need for sleep.
• D. Increased appetite and weight gain.

Correct answer: A

Rationale: The correct answer is A: Persistent thoughts about the trauma. In post-traumatic stress disorder (PTSD), individuals often experience persistent intrusive thoughts about the traumatic event, which can be distressing and disruptive. This symptom is a hallmark feature of PTSD. Choices B, C, and D are incorrect because increased energy, enthusiasm, decreased need for sleep, increased appetite, and weight gain are not typical symptoms of PTSD. Instead, individuals with PTSD may commonly experience symptoms such as flashbacks, nightmares, hypervigilance, avoidance of triggers related to the trauma, and negative changes in mood and cognition.

4. During an annual physical at a corporate clinic, a male employee tells the nurse that his high-stress job is causing trouble in his personal life. He further explains that he often gets so angry while driving to and from work that he has considered “getting even” with other drivers. How should the nurse respond?

• A. “Anger is contagious and could result in a major confrontation.”
• B. “Try not to let your anger cause you to act impulsively.”
• C. “Expressing your anger to a stranger could result in an unsafe situation.”
• D. “It sounds as if there are many situations that make you feel angry.”

Correct answer: B

Rationale: The correct response is to encourage the client to manage their anger and avoid impulsive actions, as stated in choice B. This approach helps the individual recognize the potential consequences of acting on their anger impulsively. Choice A is not the best response because it focuses on the contagious nature of anger rather than addressing the individual's behavior. Choice C is incorrect as it only highlights the potential dangers of expressing anger to a stranger without providing guidance on managing the underlying issue. Choice D acknowledges the client's feelings but does not offer practical advice on how to address the anger and potential impulsive actions.

5. What principle about patient-nurse communication should guide a nurse's fear of 'saying the wrong thing' to a patient?

• A. Patients tend to appreciate a well-meaning person who conveys genuine acceptance, respect, and concern for their situation.
• B. The patient is more interested in talking to you than listening to what you have to say and is not likely to be offended.
• C. Considering the patient's history, there is little chance that the comment will do any actual harm.
• D. Most people with a mental illness have by necessity developed a high tolerance for forgiveness.

Correct answer: A

Rationale: The correct principle guiding nurse-patient communication is that patients value genuine acceptance, respect, and concern. Choice A is the correct answer because showing genuine care and concern for the patient's situation fosters a positive and therapeutic relationship. Choice B is incorrect as effective communication involves active listening and responding appropriately, not assuming the patient is only interested in talking. Choice C is incorrect because a patient's history does not guarantee immunity to harm from inappropriate comments. Choice D is incorrect as it generalizes individuals with mental illness and forgiveness, which is not directly related to communication fears.

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