Nursing Elites

1. A client with major depressive disorder is prescribed an antidepressant. Which of the following instructions should the nurse exclude from the teaching?

• A. It may take several weeks for the medication to take effect
• B. Avoid alcohol while taking this medication
• C. Discourage the client from washing her hands
• D. You may experience an increase in energy before your mood improves

Correct answer: C

Rationale: The nurse should not include the instruction to discourage the client from washing her hands in the teaching for a client prescribed an antidepressant. This instruction is not relevant to the medication regimen. Instead, the nurse should educate the client that it may take several weeks for the medication to take effect, to avoid alcohol, not to discontinue the medication abruptly, and that there may be an increase in energy before mood improves. Regular blood tests are not typically required for most antidepressants.

2. During pregnancy, a woman is in a relationship with a male who routinely abuses her. Her unborn child may engage in high-risk behavior as a teen as a result of:

• A. Maternal stress
• B. Parental nurturing
• C. Appropriate stress responses in the brain
• D. Memories of the abuse

Correct answer: A

Rationale: Maternal stress during pregnancy can have long-term effects on the child's behavior and stress responses. Research shows that exposure to high levels of stress hormones in the womb can influence the developing fetal brain and the child's future behavior, potentially leading to high-risk behaviors during adolescence.

3. A patient with obsessive-compulsive disorder (OCD) is prescribed paroxetine. The nurse should educate the patient about which potential side effect?

• A. Insomnia
• B. Weight loss
• C. Sexual dysfunction
• D. Hypertension

Correct answer: C

Rationale: The correct answer is C, 'Sexual dysfunction.' Paroxetine, an SSRI commonly prescribed for OCD, can lead to sexual dysfunction as a side effect. Patients should be educated about this potential adverse effect to ensure they are aware and can seek appropriate management if needed. Choices A, B, and D are incorrect because insomnia, weight loss, and hypertension are not typically associated with paroxetine use as common side effects in patients with OCD.

4. In a patient with bipolar disorder, which symptom would indicate a manic episode?

• A. Excessive sleeping
• B. Low self-esteem
• C. Decreased need for sleep
• D. Anhedonia

Correct answer: C

Rationale: The correct answer is C: Decreased need for sleep. A decreased need for sleep is a hallmark symptom of a manic episode in bipolar disorder. During manic episodes, individuals may experience significantly reduced sleep without feeling tired, which can lead to increased energy levels, impulsivity, and other manic symptoms. Excessive sleeping (choice A) is more indicative of depression rather than mania. Low self-esteem (choice B) and anhedonia (choice D) are also more commonly associated with depressive episodes rather than manic episodes in bipolar disorder.

5. A patient with generalized anxiety disorder (GAD) is prescribed escitalopram. The nurse should educate the patient that the full therapeutic effect of this medication may take:

• A. 1-2 days
• B. 1-2 weeks
• C. 2-4 weeks
• D. 6-8 weeks

Correct answer: D

Rationale: Escitalopram, an SSRI used in treating generalized anxiety disorder, typically takes 6-8 weeks to achieve its full therapeutic effect. While some improvement may be noticed earlier, the maximum benefit is usually experienced after this timeframe. Options A, B, and C are incorrect because they underestimate the time required for escitalopram to reach its full effectiveness. Educating patients about the realistic timeline for medication effectiveness is crucial in managing expectations and ensuring adherence to the prescribed treatment.

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