Nursing Elites

1. The nurse observes a client who is admitted to the mental health unit and identifies that the client is talking continuously, using words that rhyme but that have no context or relationship with one topic to the next in the conversation. This client's behavior and thought processes are consistent with which syndrome?

• A. Dementia
• B. Depression
• C. Schizophrenia
• D. Chronic brain syndrome

Correct answer: C

Rationale: The client is demonstrating symptoms of schizophrenia, such as disorganized speech that may include word salad (a type of communication that mixes real and imaginary words in no logical order), incoherent speech, and clanging (rhyming). Dementia (Choice A) is characterized by memory loss and cognitive decline, not by disorganized speech. Depression (Choice B) typically presents with persistent feelings of sadness and loss of interest, not disorganized speech. Chronic brain syndrome (Choice D) is a vague term and does not specifically describe the symptoms mentioned in the scenario.

2. A client who is being treated with lithium carbonate for bipolar disorder develops diarrhea, vomiting, and drowsiness. What action should the LPN/LVN take?

• A. Notify the healthcare provider immediately and prepare for administration of an antidote.
• B. Notify the healthcare provider of the symptoms prior to the next administration of the drug.
• C. Record the symptoms as normal side effects and continue administration of the prescribed dosage.
• D. Hold the medication and refuse to administer additional amounts of the drug.

Correct answer: B

Rationale: When a client being treated with lithium carbonate for bipolar disorder develops symptoms like diarrhea, vomiting, and drowsiness, it could indicate lithium toxicity. The appropriate action for the LPN/LVN is to notify the healthcare provider immediately of these symptoms before the next administration of the drug. This prompt communication is crucial to ensure that the healthcare provider can assess the situation, adjust the treatment plan if necessary, and prevent potential complications associated with lithium toxicity. Option A is incorrect because administering an antidote should be based on the healthcare provider's assessment. Option C is incorrect as these symptoms are not normal side effects and could indicate a serious issue. Option D is incorrect because refusing to administer the drug without consulting the healthcare provider could delay necessary interventions.

3. A client with a history of alcohol dependence tells the nurse that he has been sober for three months but has recently started drinking again. What should the nurse do next?

• A. Ask the client why he started drinking again.
• B. Provide information about support groups for sobriety.
• C. Discuss the consequences of drinking on his health.
• D. Encourage the client to express his feelings about relapse.

Correct answer: D

Rationale: Encouraging the client to express his feelings about relapse is the most appropriate action for the nurse to take in this situation. This approach allows the nurse to address the underlying emotions and factors contributing to the relapse. Choice A, asking the client why he started drinking again, may come across as judgmental and might not be as effective in exploring the client's emotions. Choice B, providing information about support groups, is important but should come after addressing the client's current emotional state. Choice C, discussing the consequences of drinking, may be necessary at some point, but initially, the focus should be on the client's feelings and emotions surrounding the relapse.

4. A client with obsessive-compulsive disorder (OCD) repeatedly checks the locks on the doors. What is the best nursing intervention?

• A. Encourage the client to discuss their fears.
• B. Limit the client's time for ritualistic behavior.
• C. Assist the client to complete the ritual faster.
• D. Prevent the client from engaging in the behavior.

Correct answer: A

Rationale: The best nursing intervention when dealing with a client with OCD who repeatedly checks locks is to encourage the client to discuss their fears. This approach can help the client identify underlying anxiety triggers and work towards developing alternative coping mechanisms. Choice B, limiting the client's time for ritualistic behavior, may increase anxiety and worsen symptoms by creating a sense of urgency. Choice C, assisting the client to complete the ritual faster, does not address the underlying issues and may reinforce the behavior. Choice D, preventing the client from engaging in the behavior, can lead to increased anxiety and distress for the client.

5. A client with post-traumatic stress disorder (PTSD) is experiencing a flashback. What is the nurse's priority action?

• A. Encourage the client to talk about the trauma.
• B. Help the client to focus on the present.
• C. Administer prescribed anti-anxiety medication.
• D. Leave the client alone to work through the flashback.

Correct answer: B

Rationale: The priority action is to help the client focus on the present (B), which can reduce the intensity of the flashback. Encouraging discussion of the trauma (A) should be done when the client is not actively experiencing a flashback. While medication (C) may be necessary, it is not the first priority in this situation. Leaving the client alone (D) is not appropriate as they need support to manage the flashback.

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