Nursing Elites

1. The client is preparing to discontinue the use of a sedative-hypnotic medication. Which instruction should the nurse include?

• A. “You may experience withdrawal symptoms; these are usually mild.”
• B. “The medication will need to be gradually tapered off.”
• C. “You should increase your caffeine intake to stay alert.”
• D. “There should be no change in your sleep patterns during discontinuation.”

Correct answer: B

Rationale: When discontinuing sedative-hypnotic medications, it is crucial to gradually taper them off to prevent withdrawal symptoms. Choice A is incorrect because withdrawal symptoms can be severe, not always mild. Choice C is incorrect as increasing caffeine intake can exacerbate sleep disturbances. Choice D is incorrect because changes in sleep patterns are expected during discontinuation of sedative-hypnotic medications.

2. A male client approaches the RN with an angry expression on his face and raises his voice, saying, “My roommate is the most selfish, self-centered, angry person I have ever met. If he loses his temper one more time with me, I am going to punch him out!” The RN recognizes that the client is using which defense mechanism?

• A. Denial.
• B. Projection.
• C. Rationalization.
• D. Splitting.

Correct answer: B

Rationale: The correct answer is B: Projection. Projection involves attributing one's own unacceptable feelings or thoughts to others, as seen in the client’s accusations of his roommate’s behavior. In this scenario, the client is projecting his own anger and potential for violence onto his roommate. Choice A, Denial, involves refusing to acknowledge some aspect of reality, which is not evident in the scenario. Choice C, Rationalization, is a defense mechanism where logical reasons are given to justify behaviors that are actually based on unacceptable motives, which is not demonstrated by the client's behavior. Choice D, Splitting, is a defense mechanism where a person sees others as all good or all bad, not applicable in this case as the client is not portraying extreme views of his roommate.

3. In pediatric mental health, there is a lack of sufficient numbers of community-based resources and providers, resulting in long waiting lists for services. This has resulted in:

• A. Children of color and those in poor economic conditions being underserved
• B. Increased stress in the family unit
• C. Markedly increased funding
• D. Premature termination of services

Correct answer: D

Rationale: The correct answer is D, 'Premature termination of services.' The lack of sufficient numbers of community-based resources and providers, along with long waiting lists, can lead to premature termination of services for children in need of mental health support. Choice A, 'Children of color and those in poor economic conditions being underserved,' is not directly related to the consequence mentioned in the question. Choice B, 'Increased stress in the family unit,' while a potential consequence, is not explicitly stated in the question as a direct result of the lack of resources. Choice C, 'Markedly increased funding,' is not a consequence but rather a potential solution to address the lack of resources.

4. A male client is admitted to the psychiatric unit for recurrent negative symptoms of chronic schizophrenia and medication adjustment of risperidone (Risperdal). When the client walks to the nurse’s station in a laterally contracted position, he states that something has made his body contort into a monster. What action should the nurse take?

• A. Medicate the client with the prescribed antipsychotic thioridazine (Mellaril).
• B. Offer the client a prescribed physical therapy hot pack for muscle spasms.
• C. Administer the prescribed anticholinergic benztropine (Cogentin) for dystonia.
• D. Direct the client to occupational therapy to distract him from somatic complaints.

Correct answer: C

Rationale: The client is experiencing a dystonic reaction due to dopamine depletion, which is a known side effect of Risperidone. Dystonia presents as abnormal muscle contractions and postures. The immediate management for this side effect is the administration of an anticholinergic medication like Benztropine (Cogentin). Choice A is incorrect as thioridazine is not the recommended medication for dystonic reactions. Choice B is incorrect as a hot pack would not effectively address the underlying cause of the dystonic reaction. Choice D is incorrect as occupational therapy is not the appropriate intervention for managing acute dystonia.

5. A client who has agoraphobia (a fear of crowds) is starting desensitization therapy with the therapist, and the nurse is reinforcing the process. Which intervention has the highest priority for this client's plan of care?

• A. Encourage the substitution of positive thoughts for negative ones.
• B. Establish trust by providing a calm, safe environment.
• C. Gradually expose the client to larger crowds.
• D. Encourage deep breathing when anxiety escalates in a crowd.

Correct answer: B

Rationale: Establishing trust by providing a calm and safe environment is crucial for the success of desensitization therapy in clients with agoraphobia. This approach helps the client feel safe and secure, allowing them to gradually confront their fear of crowds. Encouraging positive thoughts (choice A) is beneficial but not as immediately critical as creating a safe space. Progressively exposing the client to larger crowds (choice C) should occur after trust is established and in a controlled manner. Encouraging deep breathing (choice D) is helpful, but creating a safe environment takes precedence to build a foundation for successful desensitization.

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