Nursing Elites

1. A client in the manic phase of bipolar disorder is pacing the hallway and talking rapidly. What is the best intervention for the nurse?

• A. Encourage the client to join a group activity.
• B. Offer the client a high-calorie snack and a drink.
• C. Direct the client to a quieter area of the unit.
• D. Instruct the client to sit down and relax.

Correct answer: B

Rationale: In the manic phase of bipolar disorder, clients often exhibit increased activity and may burn a lot of energy. Offering a high-calorie snack and a drink is the best intervention as it helps maintain their nutritional needs while allowing them to continue their activity. Encouraging the client to join a group activity (Choice A) may further stimulate their behavior. Directing the client to a quieter area (Choice C) might not address their energy expenditure. Instructing the client to sit down and relax (Choice D) may not be effective during the manic phase.

2. A male client with bipolar disorder has not slept or eaten in four days. He paces and becomes increasingly agitated and loud while the nurse talks to his spouse. What intervention is the best for the nurse to implement at this time?

• A. Move to a quiet area and provide peanut butter with crackers.
• B. Walk with the client to the cafeteria and star as he eats lunch.
• C. Request a full lunch tray from the dietary department.
• D. Encourage the spouse to eat lunch with the client.

Correct answer: A

Rationale: In this situation, the best intervention for the nurse to implement is to move the client to a quiet area and provide peanut butter with crackers. The client's behavior indicates increasing agitation and loudness, which could be exacerbated by a noisy environment. Providing a quiet space can help reduce stimuli and promote a sense of calm. Additionally, offering a small, manageable snack like peanut butter with crackers can address the client's immediate needs for sustenance without overwhelming him. Choices B, C, and D do not address the client's current agitation and lack of sleep or food effectively, making them less appropriate interventions in this scenario.

3. When caring for a client with borderline personality disorder, what is the most effective nursing intervention?

• A. Set clear and consistent boundaries for the client.
• B. Allow the client to vent their feelings without interruption.
• C. Encourage the client to participate in group therapy.
• D. Provide the client with frequent reassurance and support.

Correct answer: A

Rationale: Setting clear and consistent boundaries is essential when caring for a client with borderline personality disorder. This intervention helps provide structure, maintain a therapeutic relationship, and prevent manipulative behaviors. Allowing the client to vent feelings without interruption (Choice B) may not address the underlying issues effectively. Encouraging participation in group therapy (Choice C) can be beneficial but setting boundaries is more crucial. Providing frequent reassurance and support (Choice D) may inadvertently reinforce maladaptive behaviors instead of promoting growth and independence.

4. A client in a long-term care facility who has multiple sclerosis is embarrassed about the need to use a wheelchair and the muscle spasms that are readily visible in her legs. Which approach is therapeutic in assisting the client to cope?

• A. Keep the client in her room as much as possible
• B. Assist the client with all activities of daily living
• C. Tell the client that many of the people in the facility have these same sorts of problems
• D. Encourage and praise perseverance in performing ADLs, and assist the client to dress and groom daily

Correct answer: D

Rationale: Encouraging and praising the client's perseverance in performing activities of daily living (ADLs) is therapeutic as it helps the client maintain a sense of normalcy and dignity, thus supporting their psychosocial well-being. This approach acknowledges the client's struggles while empowering them to maintain their independence and self-care. Choices A and C are incorrect as they do not address the client's emotional needs and may contribute to further isolation and distress. Choice B, while important, does not specifically address the client's feelings of embarrassment and the need for emotional support.

5. A female client with borderline personality disorder expresses fear of being abandoned by the nursing staff. What is the best nursing intervention?

• A. Reassure the client that she will not be abandoned.
• B. Set limits on the client's behavior and enforce them consistently.
• C. Encourage the client to talk about her fears.
• D. Rotate the nursing staff assigned to the client frequently.

Correct answer: B

Rationale: The best nursing intervention for a client with borderline personality disorder expressing fear of abandonment is to set limits on the client's behavior and enforce them consistently. This approach helps establish boundaries and provides a sense of security for the client. Choice A may provide temporary reassurance but does not address the core issue or help the client develop coping strategies. Choice C is important but should be accompanied by setting limits to address the underlying fear of abandonment. Choice D of rotating staff frequently can exacerbate the client's fear of abandonment by reinforcing the idea of being left.

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