Nursing Elites

1. A male client tells the RN that he does not want to take the atypical antipsychotic drug, olanzapine (Zyprexa), because of the side effects he experienced when he took it previously. Which statement is best for the RN to provide?

• A. The medication has side effects, but they are manageable.
• B. If you refuse the medication, you will be restrained.
• C. The doctor will try another medication if this one is not effective.
• D. It is important to take the medication as prescribed for it to be effective.

Correct answer: A

Rationale: It is essential for the nurse to address the client's concerns about the side effects of the medication. By acknowledging the side effects and reassuring the client that they are manageable, the nurse empowers the client to make an informed decision about their treatment. This approach fosters trust between the client and the healthcare provider, promotes open communication, and supports treatment adherence. Choices B and D are not appropriate as they do not address the client's specific concern about the side effects or offer constructive support. Choice C is premature as switching medications should be considered after exploring ways to manage the side effects of the current medication.

2. Following involvement in a motor vehicle collision, a middle-aged adult client is admitted to the hospital with multiple facial fractures. The client’s blood alcohol level is high on admission. Which PRN prescription should be administered if the client begins to exhibit signs and symptoms of delirium tremens (DT)?

• A. Hydromorphone (Dilaudid) 2 mg IM
• B. Prochlorperazine (Compazine) 5 mg IM
• C. Chlorpromazine (Thorazine) 50 mg IM
• D. Lorazepam (Ativan) 2 mg IM

Correct answer: D

Rationale: Delirium tremens (DT) is a severe form of alcohol withdrawal that can occur in individuals with high blood alcohol levels. Lorazepam (Ativan) is the preferred medication for managing DT due to its efficacy in reducing symptoms such as agitation, hallucinations, and autonomic instability. Hydromorphone, Prochlorperazine, and Chlorpromazine are not indicated for the treatment of delirium tremens. Hydromorphone is an opioid analgesic, Prochlorperazine is an antiemetic, and Chlorpromazine is an antipsychotic. Therefore, the correct choice is Lorazepam (Ativan) to address the symptoms associated with delirium tremens effectively.

3. 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.

4. The nurse accepts a transfer to the mental health unit and understands that the client is distractible and is exhibiting a decreased ability to concentrate. The nurse has only 15 minutes to talk with the client. To develop a treatment plan for this client, which assessment is most important for the nurse to obtain?

• A. Motivation for treatment
• B. History of substance use
• C. Medication compliance
• D. Mental status examination

Correct answer: D

Rationale: A mental status examination is the most important assessment for the nurse to obtain in this scenario. It provides a comprehensive view of the client's current cognitive functioning, including their level of alertness, orientation, memory, attention, and thought process. Understanding the client's mental status is crucial for developing an appropriate treatment plan. The other options, such as motivation for treatment, history of substance use, and medication compliance, are important aspects to consider but may not directly address the client's current cognitive state and immediate treatment needs as effectively as a mental status examination.

5. A client with schizophrenia is exhibiting visual and auditory hallucinations. What should be the RN’s initial intervention?

• A. Instruct the client to ignore the hallucinations.
• B. Encourage the client to describe the hallucinations in detail.
• C. Assess the client’s perception of the hallucinations.
• D. Provide reassurance that the hallucinations are not real.

Correct answer: C

Rationale: The correct initial intervention for a client with schizophrenia exhibiting visual and auditory hallucinations is to assess the client’s perception of the hallucinations. This step is crucial as it helps the RN determine the severity of the hallucinations and the best course of action for management and intervention. Instructing the client to ignore the hallucinations (Choice A) may not be effective as the hallucinations may be distressing and overwhelming. Encouraging the client to describe the hallucinations in detail (Choice B) may potentially worsen the symptoms or trigger further distress. Providing reassurance that the hallucinations are not real (Choice D) may not be appropriate as the client may genuinely believe in their reality, and this reassurance may not address the underlying issues causing the hallucinations.

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