Nursing Elites

1. A client has been diagnosed with borderline personality disorder, and a nurse is providing care. Which intervention should the nurse implement to promote the client's safety?

• A. Implement a no-harm contract with the client.
• B. Monitor the client closely for signs of self-harm.
• C. Encourage the client to participate in recreational activities.
• D. Encourage the client to maintain a structured daily routine.

Correct answer: A

Rationale: Implementing a no-harm contract is a crucial intervention for clients with borderline personality disorder as it helps establish an agreement between the client and the healthcare provider to abstain from self-harming behaviors. This contract aims to promote the client's safety by enhancing awareness and providing a structured approach in managing impulses and emotions.

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. A client diagnosed with bipolar disorder is experiencing a manic episode. Which of the following actions should the nurse take first?

• A. Encourage the client to participate in group therapy.
• B. Place the client in a private room to decrease stimulation.
• C. Encourage the client to participate in physical activity.
• D. Administer a prescribed sedative.

Correct answer: B

Rationale: During a manic episode, individuals with bipolar disorder may be easily overstimulated. Placing the client in a private room to decrease environmental stimuli is the priority intervention. This action can help reduce the risk of exacerbating manic symptoms and promote a calmer environment for the client. Choice A is not the priority as group therapy may be overwhelming during a manic episode. Choice C could potentially increase stimulation rather than decrease it. Choice D should not be the first action as sedatives are generally not the initial intervention for managing manic episodes.

4. Which of the following symptoms should a healthcare professional expect to assess in a client diagnosed with major depressive disorder? Select one that does not apply.

• A. Loss of interest or pleasure
• B. Decreased ability to concentrate
• C. Significant weight loss or gain
• D. Increased energy

Correct answer: D

Rationale: Symptoms of major depressive disorder include a loss of interest or pleasure, decreased ability to concentrate, significant weight loss or gain, and feelings of worthlessness or excessive guilt. Increased energy is not typically associated with major depressive disorder; instead, fatigue is more common. Clients with major depressive disorder often experience a lack of energy, motivation, or enthusiasm, leading to feelings of lethargy and fatigue. Therefore, increased energy is an atypical symptom in major depressive disorder, making it the correct answer.

5. Tammy, a 28-year-old with major depressive disorder and bulimia nervosa, is ready for discharge from the county hospital after 2 weeks of inpatient therapy. Tammy is taking citalopram (Celexa) and reports that it has made her feel more hopeful. With a secondary diagnosis of bulimia nervosa, what is an alternative antidepressant to consider?

• A. Fluoxetine (Prozac)
• B. Isocarboxazid (Marplan)
• C. Amitriptyline
• D. Duloxetine (Cymbalta)

Correct answer: A

Rationale: Fluoxetine (Prozac) is a suitable alternative antidepressant for Tammy due to its approval for the treatment of bulimia nervosa. It belongs to the selective serotonin reuptake inhibitor (SSRI) class of antidepressants, similar to citalopram, which Tammy is already taking. Fluoxetine has shown efficacy in treating bulimia nervosa and can be a beneficial choice for individuals with this condition.

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