Nursing Elites

1. After surgery, a male client with antisocial personality disorder frequently requests a specific nurse be assigned to his care and becomes belligerent when another nurse is assigned. What action should the charge nurse implement?

• A. Reassure the client that his request will be met whenever possible.
• B. Advise the client that assignments are not based on client requests.
• C. Ask the client to explain why he constantly requests the nurse.
• D. Encourage the client to verbalize his feelings about the nurse.

Correct answer: B

Rationale: The correct action for the charge nurse is to advise the client that assignments are not based on client requests. Clients with antisocial personality disorder may attempt to manipulate situations to their advantage. By setting clear boundaries and explaining that assignments are not based on client preferences, the nurse helps prevent manipulation and maintains a professional approach to care. Reassuring the client about his requests (Choice A) may encourage the inappropriate behavior to continue. Asking the client to explain his requests (Choice C) may further fuel the manipulation by providing an opportunity for the client to justify his actions. Encouraging the client to verbalize feelings (Choice D) does not address the underlying issue of manipulating the assignment process and may inadvertently reinforce the behavior.

2. A female client with a history of major depressive disorder is experiencing a worsening of symptoms. Which statement by the client indicates a potential risk for suicide?

• A. “I’ve been feeling more tired than usual.”
• B. “I’ve been thinking about how much better everyone would be without me.”
• C. “I’ve been having trouble sleeping lately.”
• D. “I feel like I can’t handle everything.”

Correct answer: B

Rationale: The client’s statement about thinking that everyone would be better off without her indicates suicidal ideation. This statement is a significant warning sign for suicide risk and requires immediate intervention. Choices A, C, and D reflect common symptoms of depression but do not directly indicate suicidal thoughts or intentions. Feeling tired, having trouble sleeping, and feeling overwhelmed are typical symptoms of major depressive disorder but do not necessarily suggest an imminent risk of suicide like the statement in option B does.

3. A client with major depressive disorder is prescribed lithium carbonate. Which finding should the RN report to the healthcare provider?

• A. Serum lithium level of 0.8 mEq/L
• B. Blood urea nitrogen (BUN) level of 16 mg/dL
• C. Serum sodium level of 138 mEq/L
• D. Urine output of 800 mL in 24 hours

Correct answer: B

Rationale: The correct answer is B. Elevated BUN levels may indicate renal impairment, which is crucial to report for clients on lithium due to its potential kidney effects. Option A, a serum lithium level of 0.8 mEq/L, is within the therapeutic range for lithium and does not require immediate reporting. Option C, a serum sodium level of 138 mEq/L, is within the normal range and not directly related to lithium therapy. Option D, urine output of 800 mL in 24 hours, may indicate a need for further assessment but is not the most critical finding to report compared to potential renal impairment indicated by an elevated BUN level.

4. A male client with bipolar disorder who began taking lithium carbonate five days ago is complaining of excessive thirst, and the nurse finds him attempting to drink water from the bathroom sink faucet. Which intervention should the nurse implement?

• A. Report the client’s serum lithium level to the healthcare provider.
• B. Encourage the client to suck on hard candy to relieve the symptoms.
• C. No action is needed since polydipsia is a common side effect.
• D. Tell the client that drinking from the faucet is not allowed.

Correct answer: B

Rationale: Encouraging the client to suck on hard candy is the appropriate intervention as it can help alleviate the sensation of excessive thirst, which is a common side effect of lithium. Reporting the client’s serum lithium level to the healthcare provider may be needed if there are signs of lithium toxicity, but the priority here is to address the immediate symptom of excessive thirst. Polydipsia, or excessive thirst, is a known side effect of lithium, but it should not be left unaddressed. Simply telling the client that drinking from the faucet is not allowed does not address the underlying issue of excessive thirst and may lead to further distress.

5. When developing a plan of care for a client admitted to the psychiatric unit following aspiration of a caustic material related to a suicide attempt, which nursing problem has the highest priority?

• A. Impaired comfort.
• B. Risk for injury.
• C. Ineffective breathing pattern.
• D. Ineffective coping.

Correct answer: C

Rationale: Ineffective breathing pattern is the highest priority nursing problem in this scenario because aspiration of a caustic material can lead to serious airway and respiratory issues. This poses an immediate threat to the client's life and requires urgent intervention to ensure adequate oxygenation and ventilation. The other options, such as Impaired comfort, Risk for injury, and Ineffective coping, are important but are secondary concerns compared to the critical nature of respiratory compromise in this situation.

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