Nursing Elites

1. The LPN/LVN is caring for a client with depression who has been prescribed an SSRI. The client reports feeling more energy but is still feeling hopeless. What should the nurse be most concerned about?

• A. That the client may act on suicidal thoughts.
• B. That the client may engage in impulsive behavior.
• C. That the client may be experiencing the side effects of the medication.
• D. That the client may be at risk for developing serotonin syndrome.

Correct answer: A

Rationale: The nurse should be most concerned that the client may act on suicidal thoughts. An increase in energy combined with persistent feelings of hopelessness can indicate a higher risk of suicide. While impulsive behavior can be a concern, the primary worry should be the client's safety regarding suicidal ideation. Side effects of the medication are important to monitor but do not take precedence over the risk of self-harm. Serotonin syndrome is a potential concern with SSRIs, but in this scenario, the client's mental health and safety are the immediate priority.

2. A nurse is caring for a client who is experiencing severe anxiety. Which intervention is most appropriate for the nurse to implement?

• A. Instruct the client to take deep breaths and focus on the present.
• B. Encourage the client to discuss their fears in detail.
• C. Distract the client with a humorous story or anecdote.
• D. Leave the client alone to process their emotions.

Correct answer: A

Rationale: The correct intervention for a client experiencing severe anxiety is to instruct the client to take deep breaths and focus on the present. Deep breathing can help reduce the physiological symptoms of anxiety and provide the client with a way to regain control over their emotions. Choice B is incorrect as discussing fears in detail may escalate anxiety levels. Choice C is inappropriate as distracting the client may not address the root cause of anxiety. Choice D is not recommended as leaving the client alone can increase feelings of isolation and distress.

3. A client with schizophrenia is being discharged with a prescription for risperidone (Risperdal). What is the most important information for the nurse to provide?

• A. You need to have regular blood tests while taking this medication.
• B. Report any muscle stiffness or unusual movements immediately.
• C. Avoid foods high in tyramine while taking this medication.
• D. This medication may cause weight loss.

Correct answer: B

Rationale: The correct answer is B: "Report any muscle stiffness or unusual movements immediately." This information is crucial because muscle stiffness or unusual movements may indicate extrapyramidal symptoms (EPS), a potential side effect of risperidone that requires immediate attention. Choice A is less critical as regular blood tests are important but not as urgent as identifying EPS. Choice C is irrelevant as tyramine interactions are not associated with risperidone. Choice D is incorrect as weight gain is more common than weight loss with risperidone.

4. A client with major depressive disorder is being treated with cognitive-behavioral therapy (CBT). Which client statement indicates that CBT is having a positive effect?

• A. "I understand now that my negative thoughts are not always true."
• B. "I still feel down, but I am able to go to work."
• C. "I have stopped taking my antidepressant medication."
• D. "I avoid situations that make me feel anxious."

Correct answer: A

Rationale: The correct answer is A. Recognizing and challenging negative thoughts is a fundamental aspect of cognitive-behavioral therapy (CBT). In this statement, the client demonstrates insight into the fact that their negative thoughts may not always be accurate, showing progress in reframing their thoughts. Choice B indicates some improvement in functioning but does not directly relate to the core principles of CBT. Choice C is concerning as abruptly stopping antidepressant medication can be detrimental to the client's well-being. Choice D reflects avoidance behavior, which is typically a target for intervention in CBT rather than a sign of positive progress.

5. A male client who has been on lithium therapy for 5 years is experiencing frequent urination and increased thirst. What should the nurse's next action be?

• A. Instruct the client to increase fluid intake.
• B. Assess for signs of lithium toxicity.
• C. Suggest the client reduce salt intake.
• D. Notify the healthcare provider immediately.

Correct answer: B

Rationale: Frequent urination and increased thirst can be signs of lithium toxicity, which can lead to serious complications if not addressed promptly. Assessing for signs of lithium toxicity is crucial to determine the client's condition and prevent further harm. Instructing the client to increase fluid intake (Choice A) may worsen the situation by exacerbating lithium toxicity. Suggesting the client reduce salt intake (Choice C) is not the priority when signs of toxicity are present. Notifying the healthcare provider immediately (Choice D) is important, but the initial action should be to assess the client for signs of lithium toxicity to provide immediate care.

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