Nursing Elites

1. Unresolved feelings related to loss are most likely to be recognized during which phase of the therapeutic nurse-client relationship?

• A. Working
• B. Trusting
• C. Orientation
• D. Termination

Correct answer: D

Rationale: Unresolved feelings related to loss are often recognized and explored during the termination phase of the nurse-client relationship. This phase involves preparing the client for separation from the nurse, which can trigger unresolved feelings related to loss. During the termination phase, clients may confront their emotions about ending the therapeutic relationship and may also revisit unresolved issues or losses that have surfaced during the course of therapy. Choices A, B, and C are incorrect because the working phase focuses on active problem-solving and goal achievement, the trusting phase emphasizes establishing rapport and building trust, and the orientation phase involves initial introductions and orientation to the therapeutic process, respectively.

2. A client with schizophrenia is admitted to the psychiatric care unit for aggressive behavior, auditory hallucinations, and potential for self-harm. The client has not been taking medications as prescribed and insists that the food has been poisoned and refuses to eat. What intervention should the RN implement?

• A. Assure the client that all food served in the hospital is safe to eat.
• B. Tell the client that irrational thinking is a symptom of schizophrenia.
• C. Obtain an order for a tube feeding for the client.
• D. Provide the client with food in unopened containers.

Correct answer: D

Rationale: The correct intervention is to provide the client with food in unopened containers. This approach can help alleviate the client's fear of poisoning and encourage eating. Choice A may not address the client's specific fear and may be perceived as dismissive. Choice B, while providing information about symptoms of schizophrenia, does not address the immediate issue of the client's refusal to eat due to the fear of poisoning. Choice C of obtaining an order for tube feeding is premature and invasive before exploring less restrictive options.

3. A nurse is assessing a client with dementia who is showing signs of increased confusion and agitation in the late afternoon. What is the most likely explanation for the client's symptoms?

• A. Anxiety
• B. Depression
• C. Sun-downing syndrome
• D. Medication side effects

Correct answer: C

Rationale: The correct answer is C: Sun-downing syndrome. Sun-downing syndrome is a phenomenon commonly seen in individuals with dementia, where they exhibit increased confusion and agitation in the late afternoon or evening. This pattern of behavior is believed to be linked to disruptions in the circadian rhythm and can be triggered by factors such as fatigue, low lighting, or increased shadows during the evening. Choices A and B, anxiety and depression, may be comorbid conditions in individuals with dementia but are not the primary explanation for the symptoms described. While medication side effects (Choice D) should always be considered in a client with dementia, given the time-specific nature of the symptoms, sun-downing syndrome is the most likely explanation in this case.

4. A client with panic disorder is experiencing a panic attack. What is the nurse's priority intervention?

• A. Encourage the client to breathe slowly and deeply.
• B. Ask the client to describe the sensations they are experiencing.
• C. Encourage the client to focus on a calming image.
• D. Administer a PRN dose of lorazepam (Ativan).

Correct answer: A

Rationale: The correct answer is A. Encouraging slow, deep breathing is the priority intervention during a panic attack as it can help reduce the physiological symptoms and assist the client in regaining control. This technique can help decrease hyperventilation and promote relaxation. Choice B, asking the client to describe sensations, may be beneficial after the panic attack has subsided to gain insight into triggers or manifestations. Choice C, encouraging the client to focus on a calming image, can be helpful in managing anxiety but may not be as effective during the acute phase of a panic attack. Choice D, administering a PRN dose of lorazepam (Ativan), should only be considered if the client does not respond to initial non-pharmacological interventions or if the symptoms are severe and unmanageable.

5. When caring for a client who has overdosed on PCP, the nurse should be especially cautious about which of the following client behaviors?

• A. Visual hallucinations
• B. Violent behavior
• C. Bizarre behavior
• D. Loud screaming

Correct answer: B

Rationale: The correct answer is B: 'Violent behavior.' When a client has overdosed on PCP, the nurse should be particularly cautious about the manifestation of violent behavior. PCP overdose can lead to aggressive and unpredictable actions, posing a significant risk to both the client and healthcare providers. Visual hallucinations (choice A), bizarre behavior (choice C), and loud screaming (choice D) can also occur with PCP overdose, but the primary concern should be the potential for violent behavior, making it the most critical behavior to monitor and manage.

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