Nursing Elites

1. The nurse is caring for a client with epilepsy who is being treated with carbamazepine (Tegretol). Which laboratory value might indicate a serious side effect of this drug?

• A. Uric acid of 5 mg/dL
• B. Hematocrit of 33%
• C. WBC 2,000 per cubic millimeter
• D. Platelets 150,000 per cubic millimeter

Correct answer: C

Rationale: Carbamazepine (Tegretol) can suppress the bone marrow, leading to a decrease in the white blood cell count. A laboratory value of WBC 2,000 per cubic millimeter indicates a serious side effect of the drug. Choices A and D are within normal limits, while choice B is at the lower limit of normal. Therefore, choices A, B, and D are incorrect.

2. After group therapy, the female victim of intimate partner violence confides to the nurse that she does not feel in any immediate danger. Which of the following statements about victims of domestic violence is true?

• A. Victims of domestic violence are often the best predictors of their risk of harm.
• B. Victims of domestic violence often overestimate their safety risk.
• C. Victims of domestic violence are typically in a state of denial.
• D. Victims of domestic violence know that keeping peace with their partner is the best method of preventing another attack.

Correct answer: A

Rationale: Victims of domestic violence are often correct at predicting their risk of harm. It is crucial for the nurse to ensure that the client is expressing herself authentically and not downplaying any potential danger. While victims can be insightful about their risk, it's essential to involve proper authorities, such as the police, in situations of intimate partner violence to ensure safety and provide necessary support. Choice B is incorrect because victims may not necessarily overestimate their safety risk. Choice C is incorrect as not all victims are in a state of denial; some may recognize the dangers they face. Choice D is incorrect because victims may not believe that keeping peace with their partner is the best way to prevent future attacks, as each individual's situation and mindset vary.

3. The new mother asks why her baby has lost weight since he was born. The best explanation of the weight loss is:

• A. The baby is dehydrated due to polyuria.
• B. The baby is hypoglycemic due to lack of glucose.
• C. The baby is allergic to the formula the mother is giving him.
• D. The baby can lose up to 10% of weight due to meconium stool, loss of extracellular fluid, and initiation of breastfeeding.

Correct answer: D

Rationale: After birth, newborns can lose weight due to meconium stool, loss of extracellular fluid, and the initiation of breastfeeding. This weight loss is a normal and expected physiological process, and infants can lose up to 10% of their birth weight during this period. There is no indication of dehydration (polyuria), hypoglycemia (lack of glucose), or allergy to the formula as reasons for weight loss in newborns. Therefore, answers A, B, and C are incorrect. Answer D provides the most accurate explanation for the observed weight loss in the newborn.

4. A man reports his wife is constantly cleaning, which interferes with family life. Friends avoid visiting due to feeling uncomfortable. The husband finds her cleaning even at night. The nurse should consult and recommend the husband help with therapy by:

• A. telling his wife to stop cleaning whenever he notices her actions.
• B. making a baseline record of the time the wife spends cleaning.
• C. decreasing the stimuli in the home.
• D. helping his wife with the cleaning.

Correct answer: C

Rationale: The correct answer is to decrease the stimuli in the home. The wife's behavior suggests obsessive-compulsive disorder, an anxiety disorder. By reducing stimuli in the environment, such as clutter or triggers that prompt cleaning, it helps in managing the condition and promoting a calmer atmosphere. Option A is incorrect as directly telling the wife to stop can escalate her anxiety. Option B is not the priority initially, as addressing the root cause is more crucial. Option D may reinforce the behavior rather than addressing the underlying issue.

5. A primary belief of psychiatric mental health nursing is:

• A. Most people have the potential to change and grow.
• B. Every person is worthy of dignity and respect.
• C. Human needs are individual to each person.
• D. Some behaviors have no meaning and cannot be understood.

Correct answer: B

Rationale: The correct answer is that every person is worthy of dignity and respect. This is a fundamental principle in psychiatric mental health nursing, emphasizing the importance of treating individuals with dignity and respect regardless of their condition. This belief forms the basis of establishing a therapeutic nurse-client relationship. Choice A is a positive belief, but the primary focus in psychiatric mental health nursing is on respecting the worth and dignity of each individual. Choice C is related to understanding individual human needs but does not encompass the core value of dignity and respect. Choice D is incorrect as psychiatric nursing emphasizes the importance of interpreting and understanding all behaviors as meaningful expressions of the client's experience.

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