Nursing Elites

1. A male client is admitted to the psychiatric inpatient unit with a bandaged flesh wound after attempting to shoot himself. He was divorced one year ago, lost his job four months ago, and suffered a breakup of his current relationship last week. What is the most likely source of this client’s current feelings of depression?

• A. Feelings of frustration.
• B. A sense of loss.
• C. Poor self-esteem.
• D. A lack of intimate relationships.

Correct answer: B

Rationale: The client's recent history of divorce, job loss, and breakup of a current relationship indicates a series of significant losses. These losses are likely the primary source of his feelings of depression, leading to a sense of loss. While feelings of frustration (choice A) and poor self-esteem (choice C) could be contributing factors, the immediate trigger for his current emotional state appears to be the series of losses. A lack of intimate relationships (choice D) may be a consequence of the client's depressive symptoms rather than the root cause in this scenario.

2. The RN is leading a group on the inpatient psychiatric unit. Which approach should the RN use during the working phase of group development?

• A. Establishing a rapport with group members.
• B. Clarifying the nurse’s role and clients’ responsibilities.
• C. Discussing ways to use new coping skills learned.
• D. Helping clients identify areas of problems in their lives.

Correct answer: C

Rationale: During the working phase of group development, the focus should be on discussing and applying new coping skills to promote progress. This helps group members to practice and implement the skills they have learned, leading to positive outcomes. Choices A, B, and D are not ideal during the working phase. While establishing rapport is important, it is more relevant during the initial orientation phase. Clarifying roles and responsibilities is important at the beginning of group formation, and helping clients identify areas of problem in their lives is often part of the exploration phase, not the working phase.

3. A male client with a long history of alcohol dependency arrives in the emergency department describing the feeling of bugs crawling on his body. His BP is 170/102, pulse rate is 110 bpm, and his blood alcohol level (BAL) is 0 mg/dl. Which medication should the nurse administer?

• A. Haloperidol (Haldol)
• B. Thiamine (Vitamin B1)
• C. Diphenhydramine (Benadryl)
• D. Lorazepam (Ativan)

Correct answer: D

Rationale: In this scenario, the client is experiencing hallucinations and symptoms of alcohol withdrawal. Lorazepam (Ativan) is the appropriate choice as it helps manage withdrawal symptoms, including hallucinations and elevated blood pressure in alcohol-dependent clients. Haloperidol (Haldol) (Choice A) is an antipsychotic but is not the first-line treatment for alcohol withdrawal symptoms. Thiamine (Vitamin B1) (Choice B) is essential in alcohol withdrawal treatment for preventing Wernicke's encephalopathy, but in this case, addressing the acute withdrawal symptoms is the priority. Diphenhydramine (Benadryl) (Choice C) is an antihistamine that may help with itching or mild anxiety but is not the preferred choice for managing alcohol withdrawal symptoms like hallucinations and elevated blood pressure.

4. While working with a male client at a community mental health center, the client reports hearing voices that tell him to get a knife from the kitchen and hurt himself. What intervention is most important for the RN to implement?

• A. Prevent the client from going into the kitchen until the hallucination subsides.
• B. Report the behavior to the client’s case worker to inform the family.
• C. Assign a UAP to stay with the client continually.
• D. Document the behavior in the client’s record and notify the HCP.

Correct answer: A

Rationale: The most crucial intervention for the RN to implement in this scenario is to prevent the client from accessing the kitchen where potential means of self-harm are available until the hallucination subsides. This immediate action is necessary to ensure the client's safety. While reporting the behavior to the client's case worker for further support is important, addressing the immediate risk of harm takes precedence. Assigning a UAP to stay with the client continually is valuable for ongoing monitoring but is secondary to ensuring immediate safety. Documenting the behavior in the client's record and notifying the healthcare provider are essential steps in the care process; however, they should follow actions taken to ensure the client's immediate safety.

5. A client with depression and a history of a recent suicide attempt is being discharged from the hospital. Which statement by the client indicates a need for further follow-up?

• A. “I will take my medication as prescribed.”
• B. “I have a plan to attend weekly therapy sessions.”
• C. “I feel that I am completely recovered now.”
• D. “I will avoid people who make me feel worse.”

Correct answer: C

Rationale: The correct answer is C. When a client with depression and a history of a recent suicide attempt states, “I feel that I am completely recovered now,” it indicates a need for further follow-up. This statement suggests a potential lack of insight into the ongoing nature of depression and may lead to discontinuation of necessary treatment and support. Choices A, B, and D demonstrate positive and proactive attitudes towards managing depression and suicidal ideation, indicating a willingness to engage in treatment, therapy, and self-care practices.

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