Nursing Elites

1. The LPN/LVN is assessing a client's intelligence. Which factor should the nurse remember during this part of the mental status exam?

• A. Acute psychiatric illnesses impair intelligence.
• B. Intelligence is influenced by social and cultural factors.
• C. Poor concentration skills suggest limited intelligence.
• D. The inability to think abstractly indicates limited intelligence.

Correct answer: B

Rationale: The correct answer is B because intelligence is influenced by social and cultural factors. Social and cultural beliefs can impact how intelligence is perceived and expressed. Choice A is incorrect because acute psychiatric illnesses can affect cognitive functioning but not necessarily intelligence. Choice C is incorrect because poor concentration skills do not always correlate with limited intelligence. Choice D is incorrect because the inability to think abstractly is just one aspect of intelligence and does not solely indicate limited intelligence.

2. For a female client with major depressive disorder reporting feelings of hopelessness and helplessness, what is the nurse's priority intervention?

• A. Encourage the client to join a support group.
• B. Refer the client for cognitive-behavioral therapy (CBT).
• C. Assess the client's risk for suicide.
• D. Suggest the client participate in daily exercise.

Correct answer: C

Rationale: The correct answer is to assess the client's risk for suicide. When a client expresses feelings of hopelessness and helplessness, it indicates a high risk of self-harm or suicide. Therefore, the priority intervention should be to assess the client's safety. Encouraging the client to join a support group (choice A) may be beneficial but not the priority at this time. Referring the client for cognitive-behavioral therapy (CBT) (choice B) and suggesting daily exercise (choice D) are important interventions in managing depression but assessing the risk for suicide takes precedence due to the immediate safety concern.

3. A newly admitted client describes her mission in life as one of saving her son by eliminating the 'provocative sluts' of the world. There are several attractive young women on the unit. What should the LPN/LVN do first?

• A. Ask the client for her definition of 'provocative sluts'
• B. Ask the young female clients on the unit to dress less provocatively
• C. Ask the client to discuss her concerns in the next group session
• D. Ask the client to inform the staff if she has negative thoughts about other clients

Correct answer: D

Rationale: The correct action for the LPN/LVN to take first is to ask the client to inform the staff if she has negative thoughts about other clients. This approach is crucial as it helps in monitoring the client's thoughts and behaviors, potentially preventing any harmful actions towards others on the unit. Asking for the client's definition of 'provocative sluts' (Choice A) may not address the immediate concern of monitoring the client's harmful thoughts. Asking the young female clients to dress less provocatively (Choice B) is inappropriate and victim-blaming. Asking the client to discuss her concerns in the next group session (Choice C) may not be effective in addressing the potential harm the client's thoughts could pose to others on the unit.

4. An elderly client was prescribed Ativan 1 mg three times a day to help calm her anxiety after her husband's death. The next day the client calls her daughter asking when she is picking her up to go to the graveside. The client says she has been walking up and down the driveway for the past hour waiting for her daughter. Noting the client's agitation, hyperactivity, and insistence, the daughter calls the nurse to report her mother's behavior. What should the nurse suspect?

• A. The client is manic and may need a sleeping pill
• B. The client is experiencing a medication interaction and should go to the ED
• C. The client is experiencing a paradoxical reaction to the Ativan and should stop the new medication immediately
• D. The client is overcome by grief and probably needs an antidepressant

Correct answer: C

Rationale: A paradoxical reaction to Ativan, where the drug causes opposite effects such as increased agitation and hyperactivity, should prompt immediate cessation of the medication. In this scenario, the client was prescribed Ativan to help calm her anxiety, but instead, she is displaying symptoms of increased agitation and hyperactivity, indicating a paradoxical reaction. Choice A is incorrect because the symptoms described do not align with mania. Choice B is incorrect as there is no mention of a medication interaction. Choice D is incorrect as the symptoms are more indicative of a paradoxical reaction rather than overwhelming grief.

5. What is the priority intervention for a client with major depressive disorder admitted to the psychiatric unit with suicidal ideation?

• A. Conduct a thorough suicide risk assessment.
• B. Encourage the client to verbalize their feelings.
• C. Provide the client with positive affirmations.
• D. Refer the client to group therapy.

Correct answer: A

Rationale: The correct answer is to conduct a thorough suicide risk assessment. When a client with major depressive disorder presents with suicidal ideation, the priority is to assess the level of risk to ensure the client's safety. This assessment helps determine the appropriate interventions, level of care, and monitoring needed. Encouraging the client to verbalize their feelings (choice B) is important, but not the priority when immediate safety is a concern. Providing positive affirmations (choice C) and referring the client to group therapy (choice D) may be beneficial interventions later on but do not address the immediate risk of harm to the client.

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