Nursing Elites

1. A healthcare provider is providing education to the family of a client who has been diagnosed with bipolar disorder. Which of the following instructions should the healthcare provider include?

• A. The client should avoid all stressful situations.
• B. Encourage the client to get plenty of rest.
• C. Make sure the client takes prescribed medications regularly.
• D. Provide the client with information about support groups.

Correct answer: C

Rationale: The correct answer is C: 'Make sure the client takes prescribed medications regularly.' Consistent medication adherence is crucial in managing the symptoms and stabilizing mood in individuals with bipolar disorder. Choice A is incorrect because avoiding all stressful situations is often not feasible and not the primary treatment approach for bipolar disorder. Choice B, while important, is not as critical as ensuring medication compliance. Choice D is helpful but not as essential as medication adherence for the treatment of bipolar disorder.

2. A patient presents in the Emergency Department immediately following a shooting incident in a school where she has been teaching. There is no evidence of physical injury, but she appears very hyperactive and talkative. Which of these symptoms manifested by the patient is an uncommon initial biological response to stress?

• A. Constricted pupils
• B. Watery eyes
• C. Palpitations
• D. Increased heart rate

Correct answer: A

Rationale: Increased lacrimal secretions, palpitations, and increased heart rate are common initial biological responses to stress. Constricted pupils are not typical in the initial response to stress and are more associated with the opposite response, the Rest and Digest system. Watery eyes, palpitations, and increased heart rate are indicative of the body's fight or flight response to stress. Unusual food cravings are not a typical biological response to stress.

3. A patient with major depressive disorder has been prescribed an MAOI. The patient should be educated to avoid which type of food to prevent hypertensive crises?

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

Correct answer: C

Rationale: The correct answer is C: Tyramine-rich foods. Patients prescribed MAOIs should avoid tyramine-rich foods to prevent hypertensive crises. Tyramine-rich foods can interact with MAOIs, leading to a sudden and dangerous increase in blood pressure. Examples of tyramine-rich foods include aged cheeses, cured meats, pickled or fermented foods, and certain beverages like beer and wine. Choices A, B, and D are incorrect because they are not associated with causing hypertensive crises when taken with MAOIs.

4. In a patient with bipolar disorder, which symptom would indicate a manic episode?

• A. Excessive sleeping
• B. Low self-esteem
• C. Decreased need for sleep
• D. Anhedonia

Correct answer: C

Rationale: The correct answer is C: Decreased need for sleep. A decreased need for sleep is a hallmark symptom of a manic episode in bipolar disorder. During manic episodes, individuals may experience significantly reduced sleep without feeling tired, which can lead to increased energy levels, impulsivity, and other manic symptoms. Excessive sleeping (choice A) is more indicative of depression rather than mania. Low self-esteem (choice B) and anhedonia (choice D) are also more commonly associated with depressive episodes rather than manic episodes in bipolar disorder.

5. A client with major depressive disorder is prescribed an antidepressant. Which of the following instructions should the nurse include in the teaching? Select the one that does not apply.

• A. It may take several weeks for the medication to take effect
• B. Avoid alcohol while taking this medication
• C. Discontinue the medication abruptly
• D. You may experience an increase in energy before your mood improves

Correct answer: C

Rationale: Teaching for a client prescribed an antidepressant should include several key instructions. Firstly, it's important to inform the client that it may take several weeks for the medication to take effect, so they should be patient. Secondly, they should be advised to avoid alcohol while taking the medication as it can interact negatively with antidepressants. Additionally, abrupt discontinuation of antidepressants can lead to withdrawal symptoms and should be avoided. Lastly, clients may experience an increase in energy before their mood improves, which is a common effect of some antidepressants. Regular blood tests are not typically required for most antidepressants, but adherence to the prescribed regimen and reporting any concerning side effects to the healthcare provider are crucial.

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