Nursing Elites

1. A client with major depressive disorder is receiving cognitive-behavioral therapy (CBT). Which outcome indicates that the therapy is effective?

• A. The client identifies and challenges negative thoughts.
• B. The client reports an increase in suicidal thoughts.
• C. The client experiences an increase in anxiety.
• D. The client shows no change in behavior.

Correct answer: A

Rationale: In cognitive-behavioral therapy, identifying and challenging negative thoughts is a fundamental aspect of the treatment process. This cognitive restructuring helps individuals with major depressive disorder to develop healthier thinking patterns and cope more effectively with their emotions, which ultimately leads to improvement in their mental health. Therefore, when a client is able to identify and challenge negative thoughts, it indicates that they are actively engaging in the therapeutic process and making progress towards better mental well-being.

2. When a husband accuses his wife of infidelity, which situation would indicate to the nurse the husband's use of the ego defense mechanism of projection?

• A. The husband cries and stamps his feet, demanding that his wife be true to her marriage vows.
• B. The husband ignores the wife's continued absence from the home.
• C. The husband has already admitted to having an affair with a coworker.
• D. The husband takes out his marital frustrations through employee abuse.

Correct answer: C

Rationale: Projection is a defense mechanism where one attributes their unacceptable feelings or impulses to another person. In this scenario, the husband, by admitting to having an affair with a coworker, is projecting his infidelity onto his wife, indicating the use of the projection defense mechanism. Choice A is incorrect as it describes a different behavior, not projection. Choice B does not demonstrate projection but rather avoidance or denial. Choice D shows displacement of aggression, not projection.

3. Identical twins vary in their responses to stress. One twin may become anxious and irritable, while the other may withdraw and cry. How should the nurse explain these different reactions to stress to the parents?

• A. Reactions to stress are relative rather than absolute; individual responses to stress vary.
• B. It is abnormal for identical twins to react differently to similar stressors.
• C. Identical twins should share the same temperament and respond similarly to stress.
• D. Environmental influences weigh more heavily than genetic influences on reactions to stress.

Correct answer: A

Rationale: Individual responses to stress can vary significantly due to factors such as perception, past experiences, and environmental influences, in addition to genetic factors. It is not unusual for identical twins to exhibit different reactions to stress as their individual personalities and coping mechanisms play a significant role in how they respond to stressful situations. Choice A is the correct answer because it acknowledges the variability in responses to stress among individuals. Choice B is incorrect because it wrongly labels differing reactions in identical twins as abnormal, when in reality, it is a natural phenomenon. Choice C is incorrect as it assumes that identical twins should always have the same temperament and response to stress, which is not always the case. Choice D is incorrect because it oversimplifies the complex interplay between genetic and environmental factors in shaping responses to stress.

4. Which client statement indicates an understanding of the education provided about the antidepressant medication sertraline (Zoloft)?

• A. I should take this medication on an empty stomach.
• B. It may take several weeks for this medication to be effective.
• C. I can stop taking this medication when I feel better.
• D. I should avoid taking this medication with other medications.

Correct answer: B

Rationale: Choice B is the correct answer. It is crucial for clients to understand that sertraline (Zoloft) may take several weeks to show its full effects. Patients should be informed about this delay in onset of action to set realistic expectations and adhere to the treatment plan. This education helps prevent premature discontinuation of the medication due to perceived lack of efficacy. Choices A, C, and D are incorrect. Choice A is inaccurate because sertraline (Zoloft) should be taken with food to reduce the risk of gastrointestinal side effects. Choice C is incorrect because abruptly stopping the medication can lead to withdrawal symptoms and worsening of the condition. Choice D is inaccurate as there are specific medications that should be avoided with sertraline, but a general statement to avoid all other medications is overly broad and not necessary.

5. Natasha's husband died suddenly two months ago, and she has been overwhelmed with grief. When Natasha is subsequently diagnosed with major depressive disorder, her daughter, Nadia, makes which true statement?

• A. Depression often begins after a major loss. Losing dad was a major loss.
• B. Bereavement and depression are the same problem.
• C. Mourning is pathological and not normal behavior.
• D. Antidepressant medications will not help this type of depression.

Correct answer: A

Rationale: When individuals experience a significant loss, such as the death of a loved one, it can trigger major depressive disorder. This is because the intense grief and sadness associated with the loss can lead to the development of depressive symptoms. Therefore, Nadia's statement that 'Depression often begins after a major loss' is accurate in this context.

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