Nursing Elites

1. A client diagnosed with obsessive-compulsive disorder (OCD) engages in repetitive hand washing that lasts for several hours. Which strategy should the nurse use to manage this behavior?

• A. Encourage the client to continue the behavior to alleviate anxiety.
• B. Establish a routine schedule for hand washing.
• C. Gradually reduce the amount of time spent on the behavior.
• D. Ignore the behavior as much as possible.

Correct answer: C

Rationale: In managing obsessive-compulsive disorder (OCD), it's crucial to gradually reduce the compulsive behavior to help the client learn to manage anxiety in a structured manner. Encouraging the client to continue the behavior (Choice A) would reinforce the cycle of compulsions. While establishing a routine schedule (Choice B) may provide some structure, it doesn't address the core issue of excessive hand washing. Ignoring the behavior (Choice D) may lead to worsening symptoms and does not help the client in managing their OCD effectively.

2. A female client requests that her husband be allowed to stay in the room during the admission assessment. While interviewing the client, the nurse notes a discrepancy between the client’s verbal and nonverbal communication. What action should the nurse take?

• A. Pay close attention and document the nonverbal messages.
• B. Ask the client’s husband to interpret the discrepancy.
• C. Ignore the nonverbal behavior and focus on the client’s verbal messages.
• D. Integrate the verbal and nonverbal messages and interpret them as one.

Correct answer: A

Rationale: When a nurse observes a discrepancy between a client's verbal and nonverbal communication, it is essential to pay close attention and document the nonverbal messages. Nonverbal cues, such as body language and facial expressions, can provide valuable insights into the client's emotional state, feelings, and concerns that may not be expressed verbally. By documenting these nonverbal messages, the nurse can gain a more comprehensive understanding of the client's communication and address any potential underlying issues. Asking the client's husband to interpret the discrepancy (Choice B) may not always provide an accurate understanding of the client's nonverbal cues. Ignoring the nonverbal behavior (Choice C) could lead to missing important cues affecting the client's care. Integrating verbal and nonverbal messages (Choice D) is important, but initially focusing on documenting and understanding the nonverbal cues can enhance the nurse's assessment and communication with the client.

3. When preparing to administer a prescribed medication to a homeless male at a community psychiatric clinic, the client tells the nurse that he usually takes a different dosage. What action should the nurse take?

• A. Tell him to take the medication then verify the dosage at the next healthcare team meeting.
• B. Withhold the medication until the dosage can be confirmed.
• C. Inform him that he may refuse the medication and document whether or not he takes it.
• D. Explain to the client that the dosage has been changed.

Correct answer: B

Rationale: Withholding the medication until the dosage can be confirmed ensures patient safety and accuracy in treatment.

4. When preparing to administer a domestic violence screening tool to a female client, which statement should the RN provide?

• A. If domestic abuse is happening, I need to ask these questions.
• B. State law requires that all clients are screened for domestic violence.
• C. It is essential for us to know if you are experiencing any domestic abuse.
• D. All clients are screened for domestic abuse because it is common in our society.

Correct answer: D

Rationale: The correct answer is D because screening all clients for domestic abuse helps normalize the process and reduces the stigma, encouraging honest responses. Choice A is not the best option as it may come off as accusatory and can deter the client from being open. Choice B, mentioning state law, may create fear or pressure, affecting the client's response. Choice C focuses on the healthcare provider's needs rather than emphasizing the client's well-being, which may not facilitate open communication.

5. James is a 42-year-old patient with schizophrenia. He approaches you as you arrive for day shift and anxiously reports, 'Last night, demons came to my room and tried to rape me.' Which response would be most therapeutic?

• A. There are no such things as demons. What you saw were hallucinations.
• B. It is not possible for anyone to enter your room at night. You are safe here.
• C. You seem very upset. Please tell me more about what you experienced last night.
• D. That must have been very frightening, but we will check on you at night and you will be safe.

Correct answer: C

Rationale: Choice C is the most therapeutic response as it acknowledges the patient's feelings and encourages further exploration of their experience. By expressing empathy and inviting James to share more about what he experienced, it helps build trust and rapport. Choices A and B dismiss the patient's experience and can make them feel invalidated, which is not helpful in establishing a therapeutic relationship. Choice D acknowledges the fear but does not actively engage the patient in discussing their feelings and experiences, missing an opportunity for therapeutic communication.

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