Nursing Elites

1. What intervention is best for the nurse to implement for a male client with schizophrenia who is demonstrating echolalia, which is becoming annoying to other clients on the unit?

• A. Avoid acknowledging the behavior.
• B. Isolate the client from other clients.
• C. Administer a PRN sedative.
• D. Escort the client to his room.

Correct answer: D

Rationale: Echolalia, the constant repetition of what others are saying, can be disruptive to the therapeutic environment. The most appropriate intervention is to escort the client to his room. This action provides the client with a private space where he can engage in the behavior without disturbing other clients. Avoiding acknowledgment of the behavior (Choice A) may not address the issue and could lead to increased annoyance among other clients. Isolating the client (Choice B) may have negative psychological effects and should be avoided unless absolutely necessary for safety concerns. Administering a PRN sedative (Choice C) should be considered only as a last resort and if other de-escalation techniques have been unsuccessful.

2. A female client with obsessive-compulsive personality disorder is admitted to the hospital for a cardiac catheterization. The afternoon before the procedure, the client begins to keep detailed notes of the nursing care she is receiving and reports her findings to the RN at bedtime. What action should the nurse implement?

• A. Explain to the client that her behavior invades the rights of the nursing staff.
• B. Ask the client to explain why she is keeping a detailed record of her nursing care.
• C. Teach the client strategies to control her obsessive-compulsive behavior.
• D. Encourage the client to express her feelings regarding the upcoming procedure.

Correct answer: B

Rationale: Asking the client to explain why she is keeping a detailed record of her nursing care is the most appropriate action for the nurse to take in this situation. Understanding the client’s motivations for keeping detailed records can provide insight into her obsessive-compulsive behaviors and help manage them effectively. This approach allows for a non-confrontational exploration of the behavior. Choice A is incorrect because it may be perceived as confrontational and does not address the underlying reasons for the behavior. Choice C is incorrect because teaching strategies to control behavior should come after understanding the client's motives. Choice D is incorrect as it does not directly address the behavior of keeping detailed records, which is the immediate concern that needs to be addressed.

3. A client with postpartum depression receives a prescription for sertraline (Zoloft). What information is most important to include in client teaching?

• A. Avoid foods high in tyramine, such as processed meats, red wine, and Swiss cheese.
• B. Contact the healthcare provider immediately if suicidal thoughts occur.
• C. Increase activity level to include regular exercise.
• D. Contact the healthcare provider immediately if muscle stiffness occurs.

Correct answer: B

Rationale: The most critical information to include in client teaching for a client with postpartum depression starting sertraline (Zoloft) is to contact the healthcare provider immediately if suicidal thoughts occur. This is vital for the client's safety as antidepressants, including sertraline, can sometimes increase the risk of suicidal thoughts, especially at the start of treatment. Choices A, C, and D are not the most crucial information in this scenario. Choice A about avoiding foods high in tyramine is not directly related to sertraline use. Choice C about increasing activity level is important but not as critical as addressing suicidal ideation. Choice D about muscle stiffness is a potential side effect of sertraline but is not as urgent as monitoring for suicidal thoughts.

4. Which statement made by a patient prescribed bupropion (Wellbutrin) demonstrates that the medication education the patient received was effective? Select all that apply.

• A. I hope Wellbutrin will help my depression and also help me to finally quit smoking.
• B. I'm happy to hear that I won't need to worry too much about weight gain.
• C. It's okay to take Wellbutrin since I haven't had a seizure in 6 months.
• D. I need to be careful about driving since the medication could make me drowsy.

Correct answer: A

Rationale: Choice A is the correct answer. The patient expressing a desire for Wellbutrin to address both depression and smoking cessation indicates an understanding of the medication's dual benefits. This demonstrates effective medication education as the patient comprehends the drug's purposes. Choice B is incorrect because weight gain is a common side effect of bupropion, so the statement contradicts this fact. Choice C is incorrect as a history of seizures is a contraindication for bupropion, so this statement shows a misunderstanding of the medication's safety profile. Choice D is incorrect because bupropion is not typically associated with sedation, so the concern about drowsiness is not directly related to this medication.

5. Carolina is surprised when her patient does not show for a regularly scheduled appointment. When contacted, the patient states, 'I don't need to come see you anymore. I have found a therapy app on my phone that I love.' How should Carolina respond to this news?

• A. That sounds exciting, would you be willing to visit and show me the app?
• B. At this time, there is no real evidence that the app can replace our therapy.
• C. I am not sure that is a good idea right now; we are so close to progress.
• D. Why would you think that is a better option than meeting with me?

Correct answer: A

Rationale: Carolina should respond with choice A as it shows interest and willingness to understand the patient's new approach. By asking the patient to show the app, Carolina demonstrates openness to exploring the patient's perspective and the technology they find helpful. Choice B is incorrect as it appears dismissive, failing to acknowledge the patient's autonomy in choosing an alternative therapy method. Choice C is also inappropriate as it undermines the patient's decision-making and progress achieved so far. Choice D comes off as confrontational and judgmental, which could lead to the patient feeling defensive and less likely to engage in a constructive conversation.

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