Nursing Elites

1. Which client statement suggests that the client is using a defense mechanism of projection to deal with anxiety related to admission to a psychiatric unit?

• A. At least I hit the wall instead of hitting the psychiatric aide.
• B. I am here because the police thought I was doing something wrong.
• C. I want to be here because I know it is the best psychiatric facility.
• D. Don’t believe everything my family tells you, I am not crazy.

Correct answer: A

Rationale: The correct answer is A because the client is projecting their own aggressive tendencies onto the psychiatric aide by suggesting hitting the wall instead of the aide. This statement reflects projection, a defense mechanism where one attributes their unacceptable feelings or impulses to others. Choice B reflects externalization rather than projection, Choice C reflects rationalization, and Choice D reflects denial.

2. A teenager who has lost 20 pounds in the last three months is admitted to the hospital with hypotension and tachycardia. The client reports irregular menses and hair loss. Which intervention is most important for the nurse to include in the client’s plan of care?

• A. Initiate caloric and nutritional therapy.
• B. Implement behavioral modification therapy.
• C. Evaluate the client for low self-esteem.
• D. Record daily weights and graph trends.

Correct answer: A

Rationale: The client presents with evidence of anorexia nervosa resulting from self-starvation, which is a life-threatening condition. Providing nutrition and calories is the priority intervention so that the risk of electrolyte imbalance and severe dehydration can be reduced. Behavioral modification therapy (Choice B) may be beneficial in the long term but is not the priority in this acute situation. Evaluating for low self-esteem (Choice C) may be part of the nursing assessment but does not address the immediate life-threatening issues. Recording daily weights and graphing trends (Choice D) is important for monitoring progress but does not address the critical need for nutritional therapy in this case.

3. A male client with schizophrenia is admitted to the mental health unit after abruptly stopping his prescription for ziprasidone (Geodon) one month ago. Which question is most important for the RN to ask the client?

• A. Have you lost interest in the activities you once enjoyed?
• B. Is your ability to think or concentrate reduced?
• C. How many consecutive hours do you sleep at night?
• D. Do you hear sounds or voices that others do not hear?

Correct answer: D

Rationale: In this scenario, the most critical question for the RN to ask the client relates to hallucinations. Hallucinations, such as hearing sounds or voices others do not hear, are a hallmark symptom of schizophrenia. This inquiry is vital for assessing the presence of psychotic symptoms and the potential relapse of the client's condition. Choices A, B, and C, although important in assessing overall mental health, do not directly address the core symptomatology of schizophrenia or the potential impact of discontinuing antipsychotic medication abruptly.

4. The RN is admitting a male client who takes lithium carbonate (Eskalith) twice a day. Which information should the RN report to the HCP immediately?

• A. Short-term memory loss.
• B. Five-pound weight gain.
• C. Decreased affect.
• D. Nausea and vomiting.

Correct answer: D

Rationale: Nausea and vomiting are signs of potential lithium toxicity, which is a serious condition requiring immediate attention. These symptoms can indicate a dangerous level of lithium in the body that can lead to severe complications. Short-term memory loss (A), five-pound weight gain (B), and decreased affect (C) are important to monitor but are not as immediately concerning as symptoms of potential toxicity like nausea and vomiting.

5. A client with a history of bipolar disorder is stabilized on a mood stabilizer and has been prescribed lamotrigine (Lamictal). Which outcome indicates that the medication is effective?

• A. Decrease in manic episodes.
• B. Improvement in depressive symptoms.
• C. Reduction in anxiety symptoms.
• D. Increased sleep duration.

Correct answer: B

Rationale: The correct answer is B: Improvement in depressive symptoms. Lamotrigine is commonly used as a mood stabilizer and is particularly effective in managing depressive symptoms in bipolar disorder. While it may also help with preventing manic episodes, its primary indication is for treating depressive symptoms. Choices A, C, and D are incorrect because lamotrigine is not specifically indicated for reducing manic episodes, anxiety symptoms, or increasing sleep duration in bipolar disorder.

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