Nursing Elites

1. A client says, 'The doctors lied about me. They said I murdered my mother. You killed her. She died before I was born.' Which psychotic feature is the client experiencing?

• A. Ideas of grandeur
• B. Confusing illusions
• C. Persecutory delusions
• D. Auditory hallucinations

Correct answer: C

Rationale: The client is experiencing persecutory delusions, as she believes that others are blaming her for negative actions. This is not about ideas of grandeur, which involve feelings of greatness or power. Confusing illusions refer to misinterpretation of stimuli, which is not present in this scenario. Auditory hallucinations involve hearing voices, which is not the case here. In this case, the client is delusional, but not hallucinating.

2. Which term refers to a comprehensive set of thoughts or images of oneself?

• A. Global self
• B. Core self-concept
• C. Personal identity
• D. Ideal self

Correct answer: A

Rationale: The term 'Global self' specifically refers to a comprehensive set of thoughts or images about oneself. It encompasses a person's overall perception of themselves, including their beliefs, values, and self-image. 'Core self-concept' is more focused on the fundamental beliefs individuals hold about themselves, 'Personal identity' relates to the characteristics and qualities that distinguish a person from others, and 'Ideal self' represents the person an individual aspires to be rather than their current self-perception. Therefore, 'Global self' is the most appropriate term for the description provided in the question.

3. A 19-year-old client is paralyzed in a car accident. Which statement used by the client would indicate to the nurse that the client was using the mechanism of 'suppression'?

• A. "I don't remember anything about what happened to me."?
• B. "I'd rather not talk about it right now."?
• C. "It's the other entire guy's fault! He was going too fast."?
• D. "My mother is heartbroken about this."?

Correct answer: A

Rationale: The correct answer is, '"I don't remember anything about what happened to me."?' Suppression involves willfully putting an unacceptable thought or feeling out of one's mind. In this case, the client is purposely choosing not to remember details of the traumatic event to avoid dealing with the associated emotions. Choice B, '"I'd rather not talk about it right now,"?' suggests avoidance or deflection rather than active suppression. Choice C, '"It's the other entire guy's fault! He was going too fast,"?' indicates blaming someone else for the situation, which is a form of defense mechanism known as externalization. Choice D, '"My mother is heartbroken about this,"?' expresses empathy towards the mother's emotions and does not demonstrate suppression of personal feelings.

4. The client is in the withdrawal phase of adjusting to the change in body image. Which reaction cues the nurse to realize this when caring for a client who has lost an arm in a motor vehicle accident?

• A. The client is going through a grieving period.
• B. The client talks as if another person is affected.
• C. The client is willing to learn techniques to adapt.
• D. The client recognizes the reality and becomes anxious.

Correct answer: D

Rationale: In this scenario, the client's recognition of the reality and subsequent anxiety cues the nurse that the client is in the withdrawal phase of adjusting to the change in body image. During this phase, the client may refuse to discuss the change and may use withdrawal as a coping mechanism. The grieving period typically occurs during the acknowledgement phase, where the client and family come to terms with the change in physical appearance. Initially, shock and depersonalization may lead the client to talk as if another person is affected by the change. Finally, in the rehabilitation stage, the client is ready to learn techniques to adapt to the change, such as through the use of prosthetics or modifying lifestyles and goals.

5. What nonverbal action should the nurse implement to demonstrate active listening?

• A. Sit facing the client.
• B. Cross arms and legs.
• C. Avoid eye contact.
• D. Lean back in the chair.

Correct answer: A

Rationale: Active listening is effectively demonstrated through attentive verbal and nonverbal communication strategies. To convey active listening and show the client that the nurse is engaged and attentive, it is essential for the nurse to sit facing the client. This posture communicates openness and willingness to listen. Option B, crossing arms and legs, creates a barrier and can signal defensiveness or disinterest, making it an incorrect choice. Option C, avoiding eye contact, hinders the establishment of a connection and can convey disengagement. Option D, leaning back in the chair, may give the impression of disinterest or lack of engagement. Therefore, maintaining eye contact and sitting facing the client are crucial nonverbal actions to exhibit active listening and promote effective therapeutic communication.

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