Nursing Elites

1. A 10-year-old boy breaks his mother's vase while playing. When the mother asks who broke the vase, the little boy says that his sister did it. The little boy is exhibiting which defense mechanism?

• A. Projection
• B. Displacement
• C. Dissociation
• D. Sublimation

Correct answer: A

Rationale: Projection is a defense mechanism where one attributes their own unacceptable thoughts, feelings, or impulses onto another person. In this scenario, the little boy is projecting his actions onto his sister by falsely claiming she broke the vase. Displacement involves transferring emotions from the original source to a substitute target. Dissociation is a disconnection between thoughts, identity, consciousness, and memory. Sublimation is the redirection of unacceptable impulses into socially acceptable activities.

2. A client is experiencing panic attacks. Which intervention should the nurse implement to help the client manage anxiety?

• A. Encourage the client to avoid situations that trigger anxiety.
• B. Encourage the client to practice deep breathing exercises.
• C. Encourage the client to take anti-anxiety medication as prescribed.
• D. Encourage the client to engage in regular physical activity.

Correct answer: B

Rationale: During panic attacks, deep breathing exercises can help the client manage anxiety effectively by promoting relaxation and reducing the intensity of symptoms. Encouraging the client to practice deep breathing can provide a quick and accessible strategy to cope with the immediate distress of a panic attack. Choices A, C, and D are incorrect because avoiding triggering situations may reinforce avoidance behavior, anti-anxiety medication is not the first-line intervention during a panic attack, and engaging in physical activity may not be feasible or effective during an acute episode of panic.

3. A patient with schizophrenia is prescribed risperidone. The nurse should monitor the patient for which common side effect of this medication?

• A. Agranulocytosis
• B. Weight gain
• C. Hair loss
• D. Hyperthyroidism

Correct answer: B

Rationale: When a patient is prescribed risperidone, an atypical antipsychotic, the nurse should monitor for weight gain as it is a common side effect of this medication. Weight gain can occur due to metabolic changes and increased appetite associated with risperidone use. Agranulocytosis is a severe decrease in a type of white blood cells, and it is not a common side effect of risperidone. Hair loss and hyperthyroidism are also not typically associated with risperidone use.

4. Tammy, a 28-year-old with major depressive disorder and bulimia nervosa, is ready for discharge from the county hospital after 2 weeks of inpatient therapy. Tammy is taking citalopram (Celexa) and reports that it has made her feel more hopeful. With a secondary diagnosis of bulimia nervosa, what is an alternative antidepressant to consider?

• A. Fluoxetine (Prozac)
• B. Isocarboxazid (Marplan)
• C. Amitriptyline
• D. Duloxetine (Cymbalta)

Correct answer: A

Rationale: Fluoxetine (Prozac) is a suitable alternative antidepressant for Tammy due to its approval for the treatment of bulimia nervosa. It belongs to the selective serotonin reuptake inhibitor (SSRI) class of antidepressants, similar to citalopram, which Tammy is already taking. Fluoxetine has shown efficacy in treating bulimia nervosa and can be a beneficial choice for individuals with this condition.

5. In what order should the following goals be approached for a client being treated for alcoholism?

• A. Learning about dependence and recovery; abstinence and development of a support system; attaining physiological stabilization; developing alternative coping skills
• B. Developing alternative coping skills; attaining physiological stabilization; learning about dependence and recovery; abstinence and development of a support system
• C. Abstinence and development of a support system; attaining physiological stabilization; learning about dependence and recovery; developing alternative coping skills
• D. Abstinence and development of a support system; learning about dependence and recovery; attaining physiological stabilization; developing alternative coping skills

Correct answer: B

Rationale: When treating a client for alcoholism, it is important to follow a structured approach to maximize treatment effectiveness. The correct order of approaching goals is to first help the client in developing alternative coping skills to manage triggers and stressors without relying on alcohol. This is followed by attaining physiological stabilization, which involves addressing any physical health issues related to alcoholism. Next, the client should learn about dependence and recovery to understand the nature of their condition and the process of recovery. Finally, the goals of abstinence and developing a support system come into play to ensure long-term sobriety and a reliable network of support. Therefore, the correct order is: Developing alternative coping skills; attaining physiological stabilization; learning about dependence and recovery; abstinence and development of a support system.

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