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The LPN/LVN is caring for a client who has been prescribed a monoamine oxidase inhibitor (MAOI) for depression. Which statement by the client indicates a need for further teaching?
- A. I need to avoid foods that are high in tyramine, like aged cheese and cured meats.
- B. I should take this medication with food to avoid nausea.
- C. I can drink alcohol in moderation while taking this medication.
- D. I can stop taking this medication once I feel better.
Correct Answer: C
Rationale: The statement 'I can drink alcohol in moderation while taking this medication' indicates a need for further teaching because alcohol consumption can have dangerous interactions with MAOIs. MAOIs can interact with alcohol to cause a hypertensive crisis, which can be life-threatening. Choices A and B are correct statements as avoiding tyramine-rich foods and taking the medication with food can help prevent adverse effects. Choice D is incorrect because abruptly stopping an antidepressant medication like an MAOI can lead to withdrawal symptoms and a relapse of depression.
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During discharge planning for a male client with schizophrenia who insists on returning to his apartment despite being informed to move to a boarding home, what is the most important nursing diagnosis?
- 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 most important nursing diagnosis for discharge planning in this scenario is 'Ineffective denial related to situational anxiety.' The client's insistence on returning to his apartment despite being informed otherwise indicates a form of denial, possibly due to anxiety about the situational change. Focused discharge planning should address this denial and the underlying anxiety to ensure a smooth transition. Choices B, C, and D are not as relevant in this context as the primary issue lies in the client's denial and anxiety regarding the change in living arrangements, rather than coping, social interactions, or self-care deficits.
A client with bipolar disorder, manic phase, is admitted to the psychiatric unit. Which meal is most appropriate for this client?
- A. Spaghetti and meatballs
- B. Chicken salad sandwich
- C. Steak and potatoes
- D. Hamburger and fries
Correct Answer: B
Rationale: A chicken salad sandwich (B) is the most appropriate choice as it is easy to eat on the go, which is important for a client in the manic phase who may have difficulty sitting still for a meal. Spaghetti and meatballs (A) and steak and potatoes (C) require more time and effort to eat, which may be challenging for a client experiencing mania. While hamburger and fries (D) could be an option, a chicken salad sandwich is a healthier and more manageable choice, considering the client's potential hyperactive state.
A nurse notes that a depressed female client has been more withdrawn and less communicative during the past two weeks. Which intervention is most important to include in the updated plan of care for this client?
- A. Engage the client in non-threatening conversations.
- B. Schedule a daily conference with the social worker.
- C. Encourage the client's family to visit more often.
- D. Encourage the client to participate in group activities.
Correct Answer: D
Rationale: The correct answer is to encourage the client to participate in group activities. Group activities can help improve social interaction and potentially reduce feelings of isolation in depressed clients. Choice A, engaging the client in non-threatening conversations, may be helpful but may not address the underlying need for social interaction that group activities can provide. Scheduling a daily conference with the social worker (Choice B) may not directly address the client's need for social engagement. Encouraging the client's family to visit more often (Choice C) is important for support but may not provide the same level of social interaction as group activities.
A client with major depressive disorder is being treated with cognitive-behavioral therapy (CBT). Which client statement indicates that CBT is having a positive effect?
- A. "I understand now that my negative thoughts are not always true."
- B. "I still feel down, but I am able to go to work."
- C. "I have stopped taking my antidepressant medication."
- D. "I avoid situations that make me feel anxious."
Correct Answer: A
Rationale: The correct answer is A. Recognizing and challenging negative thoughts is a fundamental aspect of cognitive-behavioral therapy (CBT). In this statement, the client demonstrates insight into the fact that their negative thoughts may not always be accurate, showing progress in reframing their thoughts. Choice B indicates some improvement in functioning but does not directly relate to the core principles of CBT. Choice C is concerning as abruptly stopping antidepressant medication can be detrimental to the client's well-being. Choice D reflects avoidance behavior, which is typically a target for intervention in CBT rather than a sign of positive progress.
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.