Nursing Elites

1. The client is planning discharge for a male client with schizophrenia. The client insists that he is returning to his apartment, although the healthcare provider informed him that he will be moving to a boarding home. What is the most important nursing diagnosis for discharge planning?

• A. Ineffective denial related to situational anxiety.
• B. Ineffective coping related to inadequate support.
• C. Social isolation related to difficult interactions.
• D. Self-care deficit related to cognitive impairment.

Correct answer: A

Rationale: The best nursing diagnosis is (A) because the client is unable to acknowledge the move to a boarding home. While (B, C, and D) are potential nursing diagnoses, denial is the most critical as it is a defense mechanism preventing the client from addressing his feelings regarding the change in living arrangements.

2. Several clients with chronic mental illness and multiple substance abuse histories live in a group residential home and attend a daycare mental health facility where group and individual therapies are provided. The RN finds the common bathroom at the facility with sputum on the walls, urine in the sink and on the floors, and the toilet stopped up with tissue, paper towels, and feces. What is the priority issue that the RN should address?

• A. Medication non-compliance.
• B. Number of bathroom facilities.
• C. Infection control.
• D. Acting out behaviors.

Correct answer: C

Rationale: The priority issue that the RN should address is infection control. The unsanitary conditions in the bathroom, with sputum on the walls, urine in the sink and on the floors, and the toilet clogged with tissue, paper towels, and feces, pose a significant health risk to all residents and staff. Addressing infection control is crucial to prevent the spread of diseases and ensure the well-being of everyone in the facility. Medication non-compliance is important but not the priority in this situation. The number of bathroom facilities, while relevant, is not the immediate concern when faced with unsanitary conditions. Acting out behaviors, though a valid concern in mental health settings, are not the priority when faced with such unsanitary and potentially infectious conditions.

3. What is the most therapeutic nursing response for a client with borderline personality disorder who engages in self-mutilating behavior?

• A. Encourage the client to stop hurting themselves.
• B. Discuss what the client was feeling before self-harming.
• C. Inform the client that the behavior will be reported to their doctor.
• D. Ask the client why they hurt themselves.

Correct answer: B

Rationale: The most therapeutic nursing response for a client with borderline personality disorder engaging in self-mutilating behavior is to discuss what the client was feeling before self-harming. This approach helps in exploring the underlying triggers and emotions that lead to self-harm. Option A is directive and may come across as judgmental rather than empathetic. Option C can lead to feelings of betrayal and breach of trust. Option D is a closed-ended question that may not facilitate open communication or exploration of emotions.

4. What assessment is the priority focus for a client with major depression?

• A. Mood and affect.
• B. Suicidal ideation.
• C. Nutritional status.
• D. Fluid and electrolyte balance.

Correct answer: B

Rationale: The correct answer is B: Suicidal ideation. When dealing with a client diagnosed with major depression, assessing for suicidal ideation is of utmost importance. Individuals with major depression have an increased risk of suicide; hence, evaluating their risk for self-harm is crucial. Mood and affect, while important, come secondary to ensuring the safety of the client. Nutritional status and fluid and electrolyte balance are essential components of care but are not the priority when dealing with a client with major depression.

5. The LPN/LVN is caring for a client who has recently been diagnosed with bipolar disorder. The client asks, 'Why do I have to take medication every day?' What is the best response by the nurse?

• A. The medication will help stabilize your mood and prevent mood swings.
• B. You will need to take this medication for the rest of your life.
• C. The medication will help you feel better and more in control of your emotions.
• D. The medication is needed to control your symptoms and help you function better.

Correct answer: A

Rationale: The best response by the nurse is to explain that the medication will help stabilize the client's mood and prevent mood swings. This response provides the client with a clear understanding of how the medication works in managing bipolar disorder. Choice B is not the best response as it may cause unnecessary worry about lifelong medication dependence. Choice C is not as specific in addressing the purpose of the medication for bipolar disorder. Choice D is not as focused on the effect of the medication on mood stabilization, which is crucial in managing bipolar disorder.

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