Nursing Elites

1. A client diagnosed with paranoid schizophrenia states, 'The FBI is watching me. I see their agents everywhere.' Which is the nurse's most appropriate response?

• A. You shouldn't worry about that. It's not real.
• B. I don't see any FBI agents, but it sounds like you're feeling frightened.
• C. Let's talk about something else to take your mind off of it.
• D. Why do you think the FBI is watching you?

Correct answer: B

Rationale: Validating the client's feelings without reinforcing the delusion is important. This response acknowledges the client's fear without agreeing with the delusion. It shows empathy and understanding towards the client's emotions while not validating the delusional belief.

2. A nurse is caring for a client who has been diagnosed with schizoaffective disorder. The client states, 'I am the president of the United States.' Which of the following responses should the nurse make?

• A. You are not the president. You are a client in the hospital.
• B. Tell me more about being the president.
• C. Why do you think you are the president?
• D. Let's talk about something else.

Correct answer: C

Rationale: The nurse should avoid challenging the client's delusions directly. Asking for more information can help the nurse understand the client's experience and build rapport.

3. Which statement made by the patient demonstrates an understanding of the treatment of choice for patients managing the effects of traumatic events?

• A. I attend my therapy sessions regularly.
• B. Those intrusive memories are hidden for a reason and should stay hidden.
• C. Keeping busy is the key to achieving mental health.
• D. I've agreed to move in with my parents so I'll get the support I need.

Correct answer: A

Rationale: Regular attendance at therapy sessions is a crucial aspect of the recommended treatment for managing the effects of traumatic events. Therapy provides a safe space for individuals to process their experiences, develop coping strategies, and work towards healing and recovery. Consistent participation in therapy sessions can help patients address and overcome the impact of trauma on their mental health.

4. When preparing a teaching plan for a client with generalized anxiety disorder, which information should a healthcare professional include?

• A. Avoiding caffeine and other stimulants
• B. Engaging in regular physical activity
• C. Practicing relaxation techniques
• D. Keeping a journal of anxiety triggers

Correct answer: C

Rationale: The correct answer is C: Practicing relaxation techniques. This is a crucial aspect of managing generalized anxiety disorder. Techniques like deep breathing, progressive muscle relaxation, and mindfulness can effectively reduce anxiety levels and promote calmness. These techniques provide valuable coping mechanisms to help individuals with generalized anxiety disorder deal with stress and anxiety.\nChoice A, avoiding caffeine and other stimulants, can be beneficial but is not as central to managing generalized anxiety disorder as practicing relaxation techniques.\nChoice B, engaging in regular physical activity, is also helpful for managing anxiety, but relaxation techniques are more specific and targeted for addressing symptoms of generalized anxiety disorder.\nChoice D, keeping a journal of anxiety triggers, may be a useful strategy to identify triggers but does not directly address the immediate management of anxiety symptoms, unlike practicing relaxation techniques.

5. A client with borderline personality disorder exhibits self-mutilating behavior. Which nursing intervention should the nurse implement to address this behavior?

• A. Encourage the client to discuss underlying issues.
• B. Set firm limits on the client's behavior.
• C. Provide a safe environment to prevent self-harm.
• D. Discuss the consequences of self-mutilating behavior.

Correct answer: C

Rationale: The correct intervention when dealing with a client exhibiting self-mutilating behavior, especially with borderline personality disorder, is to provide a safe environment to prevent self-harm. This approach is crucial in ensuring the client's physical safety and well-being. Setting firm limits may be appropriate in some situations, but the immediate priority is to prevent self-harm. Encouraging the client to discuss underlying issues and discussing consequences are important aspects of therapy; however, in the case of acute self-mutilating behavior, the primary focus should be on creating a safe environment to prevent harm.

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