Nursing Elites

1. A client with bipolar disorder is experiencing a depressive episode. Which of the following interventions should the nurse avoid implementing?

• A. Encourage participation in activities
• B. Promote adequate nutrition and hydration
• C. Monitor for suicidal ideation
• D. Discourage verbalization of feelings

Correct answer: D

Rationale: In caring for a client with bipolar disorder in a depressive episode, the nurse should implement interventions that promote mental well-being. Encouraging participation in activities, promoting adequate nutrition and hydration, and monitoring for suicidal ideation are all essential components of care. Discouraging verbalization of feelings is counterproductive as it hinders the therapeutic process and communication, which are crucial for the client's emotional expression and recovery.

2. A nurse is providing education to a client diagnosed with generalized anxiety disorder (GAD). Which of the following statements by the client indicates a need for further teaching? Select one that does not apply.

• A. I should avoid caffeine because it can increase my anxiety.
• B. I can stop taking my medication once I feel better.
• C. Practicing deep breathing exercises can help reduce my anxiety.
• D. I should gradually face situations that cause me anxiety.

Correct answer: B

Rationale: Statements indicating a need for further teaching include stopping medication once feeling better and believing that medication will always be needed. Medication should be continued as prescribed, and the need for it should be regularly re-evaluated by a healthcare provider.

3. Substance abuse is often present in individuals diagnosed with bipolar disorder. Laura, a 28-year-old with a bipolar disorder diagnosis, chooses to drink alcohol instead of taking her prescribed medications. The nurse caring for this patient recognizes that:

• A. Anxiety may be present.
• B. Alcohol ingestion is a form of self-medication.
• C. The patient is lacking a sufficient number of neurotransmitters.
• D. The patient is using alcohol as a coping mechanism.

Correct answer: B

Rationale: Individuals with bipolar disorder may turn to alcohol as a form of self-medication to cope with their symptoms. This behavior is often seen as an attempt to manage mood swings and alleviate distress. It is important for healthcare providers to address and manage substance abuse issues in patients with bipolar disorder to ensure proper treatment and overall well-being.

4. A physically and emotionally healthy client has just been fired. During a routine office visit, he states to a nurse: 'Perhaps this was the best thing to happen. Maybe I'll look into pursuing an art degree.' How should the nurse characterize the client's appraisal of the job loss stressor?

• A. Irrelevant
• B. Harm/loss
• C. Threatening
• D. Challenging

Correct answer: D

Rationale: The client's statement indicates that he views the job loss as an opportunity for growth and a new direction in life rather than a threat or harm/loss. He sees it as a challenge and is considering it positively, demonstrating resilience and adaptability in the face of adversity. Choice A, 'Irrelevant,' is incorrect as the client's response shows relevance and a positive outlook. Choice B, 'Harm/loss,' is incorrect as the client does not express a sense of harm or loss but rather opportunity. Choice C, 'Threatening,' is incorrect as the client's response does not convey fear or threat but rather a positive reframe of the situation.

5. A client has been prescribed diazepam (Valium) for the treatment of anxiety. Which of the following instructions should the nurse include in the discharge teaching?

• A. Avoid drinking alcohol while taking this medication.
• B. Take the medication with food to avoid stomach upset.
• C. Stop taking the medication if you feel better.
• D. Double the dose if you miss a dose.

Correct answer: A

Rationale: The correct instruction is to avoid drinking alcohol while taking diazepam (Valium) as it can potentiate the sedative effects and increase the risk of side effects such as drowsiness and dizziness. Taking the medication with food may help reduce stomach upset, but avoiding alcohol is crucial to ensure safe and effective use of diazepam. Choice B is partially correct, as taking the medication with food can indeed help with stomach upset, but it is not as crucial as avoiding alcohol. Choice C is incorrect because abruptly stopping diazepam can lead to withdrawal symptoms and should only be done under medical supervision. Choice D is incorrect as doubling the dose is dangerous and should never be done without healthcare provider approval.

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