Nursing Elites

1. Based on non-compliance with the medication regimen, an adult client with a medical diagnosis of substance abuse and schizophrenia was recently switched from oral fluphenazine HCl (Prolixin) to IM fluphenazine decanoate (Prolixin Decanoate). What is most important to teach the client and family about this change in medication regimen?

• A. Signs and symptoms of extrapyramidal effects (EPS).
• B. Information about substance abuse and schizophrenia.
• C. The effects of alcohol and drug interaction.
• D. The availability of support groups for those with dual diagnoses.

Correct answer: C

Rationale: Teaching about the effects of alcohol and drug interaction is crucial to prevent adverse reactions, especially with the long-acting injectable form of fluphenazine. Understanding how alcohol and drugs can interact with the medication will help the client and family to ensure medication effectiveness and avoid potential harmful effects. Choices A, B, and D are not the most important to teach in this scenario. While knowing the signs and symptoms of extrapyramidal effects (EPS) is important, understanding the effects of alcohol and drug interaction is more critical in this specific situation. Information about substance abuse and schizophrenia, as well as the availability of support groups, are essential aspects of care but are not the primary focus when switching to a long-acting injectable medication due to non-compliance.

2. A client with PTSD is experiencing flashbacks and nightmares. Which intervention should the nurse implement first?

• A. Encourage the client to talk about the flashbacks.
• B. Assist the client in developing coping strategies.
• C. Discuss relaxation techniques with the client.
• D. Refer the client to a PTSD support group.

Correct answer: A

Rationale: Encouraging the client to talk about the flashbacks is the most appropriate initial intervention for a client with PTSD experiencing flashbacks and nightmares. This intervention helps the client express their feelings, thoughts, and experiences related to the trauma they are going through. It can assist in processing the traumatic events and starting the healing process. Choice B, assisting the client in developing coping strategies, is important but should come after the client has started to verbalize and process their experiences. Choice C, discussing relaxation techniques, may be beneficial later in the treatment process but may not be as effective initially as addressing the traumatic experiences. Choice D, referring the client to a PTSD support group, is also valuable but may not be as immediate as encouraging the client to talk about their flashbacks to begin the therapeutic process.

3. The nurse should hold the next scheduled dose of a client's haloperidol (Haldol) based on which assessment finding(s)?

• A. Dizziness when standing.
• B. Shuffling gait and hand tremors.
• C. Urinary retention.
• D. Fever of 102°F.

Correct answer: D

Rationale: A fever (D) may indicate neuroleptic malignant syndrome (NMS), a potentially fatal complication of antipsychotics. The healthcare provider should be contacted before administering the next dose of Haldol. Dizziness when standing (A), shuffling gait and hand tremors (B), and urinary retention (C) are all adverse effects of Haldol that, while concerning, do not pose immediate life-threatening risks compared to the potential severity of NMS indicated by a fever.

4. On admission assessment, the nurse is obtaining subjective data about a client's sexual and reproductive status. The client states, 'I don't want to discuss this; it's private and personal.' Which response by the LVN/LPN is the most therapeutic?

• A. I'd hate being asked these sorts of questions too, but it's a necessary part of providing you with the best care.
• B. This is difficult for you to speak about, but I need this information from you in order to perform a complete assessment.
• C. I am a professional registered nurse, and, as such, I'll have you know that all your information is certainly kept confidential.
• D. I know that some of these questions are difficult for you, but, as a professional nurse, I am obligated to respect your confidentiality.

Correct answer: D

Rationale: The correct response is D. Respecting the client's privacy while acknowledging the difficulty of the situation and explaining the professional obligation to maintain confidentiality is the most therapeutic approach. This response shows empathy, understanding, and a commitment to confidentiality, which can help build trust and encourage the client to open up. Choices A, B, and C do not effectively address the client's concerns or emphasize the importance of confidentiality in a sensitive manner, making them less therapeutic responses in this situation.

5. A male client is admitted to a mental health unit on Friday afternoon and is very upset on Sunday because he has not had the opportunity to talk with the healthcare provider. Which response is best for the nurse to provide this client?

• A. Let me call and leave a message for your healthcare provider.
• B. The healthcare provider should be here on Monday morning.
• C. How can I help answer your questions?
• D. What concerns do you have at this time?

Correct answer: A

Rationale: It is best for the nurse to call the healthcare provider (A) because clients have the right to information about their treatment. Suggesting that the healthcare provider will be available the following day (B) does not provide immediate reassurance to the client. While offering to help answer questions (C) and inquiring about concerns (D) are supportive approaches, contacting the healthcare provider is the most appropriate action to address the client's immediate need for communication with their healthcare provider.

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