Nursing Elites

1. A client with depression reports difficulty sleeping. What is the most appropriate nursing intervention?

• A. Encourage the client to take short naps during the day.
• B. Suggest the client drink a warm beverage before bedtime.
• C. Recommend the client exercise immediately before bedtime.
• D. Advise the client to take a sleep aid nightly.

Correct answer: B

Rationale: The most appropriate nursing intervention for a client with depression reporting difficulty sleeping is to suggest the client drink a warm beverage before bedtime. A warm beverage can promote relaxation and help establish a bedtime routine, which may aid in improving sleep quality. Encouraging short naps during the day (Choice A) may disrupt the client's nighttime sleep pattern. Recommending exercise immediately before bedtime (Choice C) can have a stimulating effect, making it harder for the client to fall asleep. Advising the client to take a sleep aid nightly (Choice D) should only be considered after other non-pharmacological interventions have been attempted and in consultation with a healthcare provider due to potential side effects and risks associated with sleep aids.

2. When preparing a teaching plan for a client who is to be discharged with a prescription for lithium carbonate (Lithonate), which instruction is most important for the nurse to include?

• A. It may take 3 to 4 weeks to achieve therapeutic effects.
• B. Keep your dietary salt intake consistent.
• C. Avoid eating aged cheese and chicken liver.
• D. Eat foods high in fiber such as whole grain breads.

Correct answer: B

Rationale: The correct answer is B: 'Keep your dietary salt intake consistent.' Consistent salt intake is crucial when taking lithium carbonate to avoid lithium toxicity or ineffectiveness due to its renal excretion mechanism. Option A is incorrect because it focuses on the time to achieve therapeutic effects, which is important but not as critical as maintaining consistent salt intake. Option C is incorrect as it mentions avoiding aged cheese and chicken liver, which is more relevant for individuals taking MAOIs. Option D is incorrect as it suggests eating high-fiber foods, which is not directly related to lithium carbonate therapy.

3. A male client with mental illness and substance dependency tells the mental health nurse that he has started using illegal drugs again and wants to seek treatment. Since he has a dual diagnosis, which person is best for the nurse to refer this client to first?

• A. The emergency room nurse.
• B. His case manager.
• C. The clinic healthcare provider.
• D. His support group sponsor.

Correct answer: B

Rationale: The case manager (B) is responsible for coordinating community services, making them the best person to refer the client to first as they can describe available treatment options. The emergency room nurse (A) is unnecessary unless the client's behaviors pose imminent threats. The clinic healthcare provider (C) and support group sponsor (D) may be useful but coordinating a treatment program tailored to the client's needs is the priority in this scenario.

4. A client with schizophrenia who has been stabilized on medication is being discharged from the hospital. What discharge teaching is most important for the LPN/LVN to reinforce?

• A. The importance of adhering to the prescribed medication regimen.
• B. How to recognize early signs of relapse.
• C. The need to continue follow-up appointments with the healthcare provider.
• D. The importance of maintaining a healthy lifestyle, including proper diet and exercise.

Correct answer: A

Rationale: The correct answer is A. Reinforcing the importance of adhering to the prescribed medication regimen is crucial for preventing relapse in clients with schizophrenia. Compliance with medication is essential in managing the symptoms and preventing a worsening of the condition. Choice B, recognizing early signs of relapse, is important but secondary to ensuring medication adherence. Choice C, follow-up appointments, is also important but not as critical as medication compliance immediately post-discharge. Choice D, maintaining a healthy lifestyle, is beneficial for overall health but is not as directly linked to preventing relapse in schizophrenia as medication adherence.

5. The nurse is taking a history for a female client who is requesting a routine female exam. Which assessment finding requires follow-up?

• A. Menstruation onset at age 9.
• B. Contraceptive method includes condoms only.
• C. Menstrual cycle occurs every 35 days.
• D. 'Black-out' after one drink last night on a date.

Correct answer: D

Rationale: The correct answer is D. Experiencing a 'black-out' after consuming only one drink is highly unusual and may indicate the client was drugged, necessitating immediate follow-up. Menstruation onset at age 9 and a menstrual cycle occurring every 35 days, although on the outer ranges of 'average,' are within acceptable norms. Relying solely on condoms as a contraceptive method increases the risk of conception.

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