Nursing Elites

1. A client with bipolar disorder is experiencing a manic episode. Which of the following interventions should the nurse avoid implementing?

• A. Provide a structured environment
• B. Encourage rest periods
• C. Limit setting on inappropriate behaviors
• D. Allow the client to engage in stimulating activities

Correct answer: D

Rationale: During a manic episode in bipolar disorder, interventions should focus on providing a structured environment, encouraging rest periods, and setting limits on inappropriate behaviors. Allowing the client to engage in stimulating activities may exacerbate the symptoms of mania, such as increased energy, impulsivity, and risk-taking behaviors. Therefore, it is important to avoid encouraging such activities to prevent worsening of manic symptoms.

2. When using therapeutic communication with a withdrawn patient who has major depression, an effective method of managing the silence is to:

• A. Engage in a quiet meditation
• B. Ask simple questions even if the patient will not answer
• C. Use the technique of making observations
• D. Simply sit quietly and leave when the patient falls asleep

Correct answer: C

Rationale: Using the technique of making observations is an effective method of managing silence when communicating with a withdrawn patient who has major depression. This approach can encourage the patient to engage and feel understood without the pressure to respond, fostering a therapeutic connection and helping the patient open up at their own pace.

3. A woman was abducted and raped at gunpoint by an unknown assailant. When found, she was confused and disoriented. The nurse makes the following observations about the client. She is talking rapidly in disjointed phrases, is unable to concentrate, and is indecisive when asked to make simple decisions. The client's level of anxiety can be assessed as

• A. moderate
• B. severe
• C. mild
• D. nonexistent

Correct answer: B

Rationale: The client's presentation, including rapid and disjointed speech, inability to concentrate, and indecisiveness, are indicative of severe anxiety. These symptoms suggest a high level of distress and impairment in cognitive functioning, which aligns with severe anxiety rather than mild or moderate levels. The traumatic experience of being abducted and raped at gunpoint would likely contribute to such a severe level of anxiety.

4. A client has been prescribed sertraline (Zoloft) for depression. Which of the following instructions should the nurse include in the discharge teaching?

• A. Take the medication in the morning to avoid daytime drowsiness.
• B. Avoid drinking alcohol while taking this medication.
• C. Take the medication with a full glass of water.
• D. Stop taking the medication if you feel better.

Correct answer: B

Rationale: The correct instruction for the nurse to include in the discharge teaching is to advise the client to avoid drinking alcohol while taking sertraline (Zoloft). Alcohol can exacerbate the side effects of the medication, such as drowsiness and dizziness, and may also decrease the effectiveness of the treatment for depression. Choice A is incorrect as sertraline is usually taken in the morning. Choice C is not a specific instruction related to the medication. Choice D is incorrect as abruptly stopping sertraline can lead to withdrawal symptoms and should only be done under medical supervision.

5. Which of the following statements about the DSM-5 is inaccurate?

• A. It includes specific criteria for diagnosing mental disorders.
• B. It is used by mental health professionals to guide diagnosis.
• C. It provides a classification system for mental disorders.
• D. It includes guidelines for the treatment of mental disorders.

Correct answer: D

Rationale: The DSM-5 is a diagnostic tool that provides specific criteria for diagnosing mental disorders, is utilized by mental health professionals to guide diagnosis, and offers a systematic classification of mental disorders. The statement that the DSM-5 includes guidelines for the treatment of mental disorders is inaccurate. The primary focus of the DSM-5 is on diagnosis and classification, not treatment. Therefore, choice D is the correct answer. Choices A, B, and C accurately describe the purpose and functions of the DSM-5.

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