Nursing Elites

1. A young adult female client is admitted to a psychiatric facility with a medical diagnosis of bulimia nervosa. Which nursing intervention has the highest priority?

• A. Schedule the client for group therapy with other clients with bulimia nervosa.
• B. Assign the client's care to a nurse with relevant experience in eating disorders.
• C. Monitor the client carefully for binging and purging activities.
• D. Assess and report the client's electrolyte status to the healthcare provider.

Correct answer: D

Rationale: The correct answer is D. Assessing and reporting the client's electrolyte status to the healthcare provider is the highest priority in a client with bulimia nervosa. Electrolyte imbalances, such as hypokalemia and metabolic alkalosis, are common due to purging behaviors associated with bulimia. Monitoring electrolyte levels is crucial to prevent life-threatening complications. Choices A, B, and C are incorrect because while therapy and monitoring for binging activities are important, addressing the electrolyte imbalances caused by purging behaviors takes precedence in the immediate care of a client with bulimia nervosa.

2. A client states that she hears God's voice telling her that she has sinned and needs to punish herself. Which response by the LPN/LVN is most important?

• A. How do you think you will be punished?
• B. Please tell staff when you think you need to punish yourself.
• C. What exactly do you think you have done to be punished?
• D. Let's talk about your strengths

Correct answer: B

Rationale: The most important response by the LPN/LVN is to encourage the client to communicate with staff when they feel the need to punish themselves. This approach can help assess the risk of self-harm and enable appropriate intervention. Choice A focuses more on the method of punishment rather than encouraging help-seeking behavior. Choice C seeks specific details about the perceived wrongdoing rather than addressing the immediate concern of self-punishment. Choice D, discussing strengths, does not directly address the client's current distress and potential self-harm risk.

3. A female client on a psychiatric unit is sweating profusely while she vigorously does push-ups and then runs the length of the corridor several times before crashing into furniture in the sitting room. Picking herself up, she begins to toss chairs aside, looking for a red one to sit in. When another client objects to the disturbance, the client shouts, 'I am the boss here. I do what I want.' Which nursing problem best supports these observations?

• A. Deficient diversional activity related to excess energy level.
• B. Risk for other-directed violence related to disruptive behavior.
• C. Risk for activity intolerance related to hyperactivity.
• D. Disturbed personal identity related to grandiosity.

Correct answer: B

Rationale: The client's disruptive and potentially harmful behavior, including tossing chairs and claiming authority, indicates a risk for other-directed violence. This behavior poses a threat to the safety of the client and others. While the client may have excess energy, the primary concern is the potential for violence, not just a lack of diversional activities (Choice A). The client's behavior is not solely due to hyperactivity leading to activity intolerance (Choice C) or grandiosity affecting personal identity (Choice D), making these options less appropriate in this context.

4. The LPN/LVN is caring for a client with schizophrenia who is experiencing auditory hallucinations. Which intervention is most appropriate?

• A. Encourage the client to focus on reality-based activities.
• B. Ask the client to describe the voices he hears.
• C. Tell the client that the voices are not real.
• D. Encourage the client to interact with others who are not experiencing hallucinations.

Correct answer: B

Rationale: Asking the client to describe the voices he hears is the most appropriate intervention in this situation. It helps the nurse assess the content and severity of the hallucinations, enabling the planning of appropriate interventions. Choice A is not as effective as directly addressing the hallucinations. Choice C may lead to mistrust as the client believes the voices are real. Choice D does not address the client's immediate need related to the hallucinations.

5. What are neurotransmitters?

• A. Chemical messengers that cause brain cells to turn on or off.
• B. Areas of the brain that are responsible for controlling emotions.
• C. Clumps of cells that alert the other brain cells to receive messages.
• D. Web-like structures that provide connections among parts of the brain.

Correct answer: A

Rationale: Neurotransmitters are chemicals in the brain that act as messengers between neurons, influencing various psychological functions. Choice A correctly defines neurotransmitters by stating that they are chemical messengers that cause brain cells to turn on or off. This is the function of neurotransmitters in transmitting signals between neurons. Choices B, C, and D are incorrect because they do not accurately describe neurotransmitters and their role in the brain.

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