Nursing Elites

1. A client has been prescribed fluoxetine (Prozac). What information should the nurse include in discharge teaching?

• A. Take the medication with food to avoid stomach upset.
• B. Avoid drinking alcohol while taking this medication.
• C. Take the medication only when feeling depressed.
• D. Report any unusual side effects to the healthcare provider.

Correct answer: B

Rationale: The correct answer is to advise the client to avoid drinking alcohol while taking fluoxetine (Prozac) due to potential interactions. Alcohol consumption can increase the risk of certain side effects and may reduce the effectiveness of the medication. Choice A is incorrect because fluoxetine can be taken with or without food. Choice C is incorrect as fluoxetine is usually taken daily regardless of the client's mood. Choice D is not the priority teaching point; while reporting side effects is important, avoiding alcohol is critical due to the potential interactions.

2. When under stress, a client routinely uses an excessive amount of alcohol. Finding her drunk, her husband yells at her about the chronic alcohol abuse. Which reaction should the nurse recognize as the use of the defense mechanism of denial?

• A. Hiding liquor bottles in a closet
• B. Yelling at their son for slouching in his chair
• C. Burning dinner on purpose
• D. Saying to the spouse, 'I don't drink too much!'

Correct answer: D

Rationale: The nurse should recognize the client's statement 'I don't drink too much!' as the use of the defense mechanism of denial. This response indicates the client's refusal to acknowledge the reality of excessive alcohol consumption, which is a key characteristic of denial. By denying the problem, the client avoids facing the negative consequences and feelings associated with their alcohol abuse. Choices A, B, and C do not exhibit denial but rather represent different defense mechanisms. Hiding liquor bottles in a closet might indicate the defense mechanism of concealment, yelling at their son for slouching in his chair could reflect displacement, and burning dinner on purpose might suggest passive-aggressive behavior.

3. 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.

4. A patient with schizophrenia is experiencing hallucinations. Which intervention is most appropriate?

• A. Encourage the patient to ignore the voices.
• B. Engage the patient in a reality-based activity.
• C. Provide a quiet environment to reduce stimulation.
• D. Ask the patient to describe the hallucinations in detail.

Correct answer: B

Rationale: Engaging the patient in a reality-based activity is the most appropriate intervention for a patient with schizophrenia experiencing hallucinations. This intervention can help distract the patient from the hallucinations and reorient them to the present, promoting a connection with reality and potentially reducing distress associated with the hallucinations. Choice A, encouraging the patient to ignore the voices, may not be effective as it can be challenging for the patient to dismiss the hallucinations. Choice C, providing a quiet environment, is helpful but may not directly address the hallucinations. Choice D, asking the patient to describe the hallucinations in detail, may increase the patient's focus on the hallucinations, potentially worsening distress.

5. Which of the following symptoms should a healthcare provider expect to assess in a client diagnosed with generalized anxiety disorder (GAD)? Select one that doesn't apply.

• A. Excessive worry
• B. Muscle tension
• C. Increased energy
• D. Restlessness

Correct answer: C

Rationale: Symptoms of generalized anxiety disorder include excessive worry, muscle tension, restlessness, and irritability. Increased energy is not typically associated with GAD; clients often experience fatigue instead. This heightened energy level is more commonly seen in conditions like mania or hypomania, rather than in GAD. Therefore, the correct answer is 'Increased energy.' Choices A, B, and D are all symptoms commonly observed in individuals with generalized anxiety disorder.

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