Nursing Elites

1. A client is experiencing alcohol withdrawal. Which intervention should be included in the plan of care?

• A. Administer benzodiazepines as prescribed.
• B. Monitor the client's vital signs every 4 hours.
• C. Provide a high-protein diet.
• D. Encourage the client to drink plenty of fluids.

Correct answer: A

Rationale: Administering benzodiazepines as prescribed is a crucial intervention in managing alcohol withdrawal. Benzodiazepines help alleviate symptoms such as anxiety, agitation, and seizures commonly seen in alcohol withdrawal. Monitoring vital signs is important to assess the client's physiological stability, but addressing the withdrawal symptoms with benzodiazepines is a priority to prevent severe complications. Providing a high-protein diet and encouraging fluid intake are important for overall health but do not directly manage alcohol withdrawal symptoms.

2. A client with bipolar disorder is prescribed lithium. Which of the following statements by the client indicates a need for further teaching?

• A. I should maintain a consistent salt intake.
• B. I should drink 6-8 glasses of water daily.
• C. I need to have my lithium levels checked regularly.
• D. I can stop taking my medication once my mood stabilizes.

Correct answer: D

Rationale: The statement "I can stop taking my medication once my mood stabilizes" indicates a need for further teaching. Clients should continue taking their medication as prescribed and have regular monitoring of lithium levels.

3. A client with bipolar disorder is in the manic phase. Which nursing intervention should the nurse implement to ensure the client's safety?

• A. Provide a structured environment with minimal stimuli.
• B. Encourage the client to participate in group activities.
• C. Monitor the client closely for signs of exhaustion.
• D. Encourage the client to rest and sleep as needed.

Correct answer: A

Rationale: During the manic phase of bipolar disorder, individuals may engage in impulsive behaviors that can put them at risk of harm. Providing a structured environment with minimal stimuli can help reduce the risk of injury by minimizing triggers for impulsive actions. This intervention promotes a safe and controlled setting for the client, which is crucial in managing the symptoms of mania. Encouraging the client to participate in group activities (Choice B) may increase stimuli and potentially exacerbate manic symptoms. Monitoring for signs of exhaustion (Choice C) is important but does not directly address the safety concerns related to impulsive behaviors during mania. Encouraging the client to rest and sleep as needed (Choice D) may be challenging during the manic phase when individuals typically experience decreased need for sleep.

4. A patient with obsessive-compulsive disorder (OCD) is prescribed paroxetine. The nurse should educate the patient about which potential side effect?

• A. Insomnia
• B. Weight loss
• C. Sexual dysfunction
• D. Hypertension

Correct answer: C

Rationale: The correct answer is C, 'Sexual dysfunction.' Paroxetine, an SSRI commonly prescribed for OCD, can lead to sexual dysfunction as a side effect. Patients should be educated about this potential adverse effect to ensure they are aware and can seek appropriate management if needed. Choices A, B, and D are incorrect because insomnia, weight loss, and hypertension are not typically associated with paroxetine use as common side effects in patients with OCD.

5. When caring for a patient with major depressive disorder prescribed an MAOI, what type of food should the nurse educate the patient to avoid?

• A. High-protein foods
• B. High-fiber foods
• C. Tyramine-rich foods
• D. Low-fat foods

Correct answer: C

Rationale: Patients prescribed MAOIs need to avoid consuming tyramine-rich foods as these can lead to hypertensive crises. Tyramine is found in various foods like aged cheeses, cured meats, some types of beer, and fermented products. Interactions between tyramine and MAOIs can result in severe hypertension, highlighting the importance of educating patients about dietary restrictions to ensure their safety. Choices A, B, and D are incorrect because high-protein foods, high-fiber foods, and low-fat foods do not pose a significant risk of hypertensive crises when taken with MAOIs. Therefore, the correct answer is C.

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