Nursing Elites

1. A client with obsessive-compulsive disorder (OCD) is undergoing behavioral therapy. Which outcome should the nurse recognize as an indication that the client is responding positively to therapy?

• A. The client reports increased frequency of obsessive thoughts.
• B. The client demonstrates a decrease in compulsive behaviors.
• C. The client expresses a desire to leave therapy early.
• D. The client avoids participating in exposure tasks.

Correct answer: B

Rationale: A decrease in compulsive behaviors is a positive response to behavioral therapy for OCD. Behavioral therapy aims to reduce these behaviors and promote healthier coping mechanisms. Option A, reporting an increased frequency of obsessive thoughts, would indicate a lack of improvement or worsening of symptoms. Option C, expressing a desire to leave therapy early, suggests resistance or dissatisfaction with therapy. Option D, avoiding participation in exposure tasks, goes against the principles of exposure therapy, which is commonly used in OCD treatment to help clients confront their fears and reduce anxiety.

2. A male client is admitted to the psychiatric inpatient unit with a bandaged flesh wound after attempting to shoot himself. He was divorced one year ago, lost his job four months ago, and suffered a breakup of his current relationship last week. What is the most likely source of this client’s current feelings of depression?

• A. Feelings of frustration.
• B. A sense of loss.
• C. Poor self-esteem.
• D. A lack of intimate relationships.

Correct answer: B

Rationale: The client's recent history of divorce, job loss, and breakup of a current relationship indicates a series of significant losses. These losses are likely the primary source of his feelings of depression, leading to a sense of loss. While feelings of frustration (choice A) and poor self-esteem (choice C) could be contributing factors, the immediate trigger for his current emotional state appears to be the series of losses. A lack of intimate relationships (choice D) may be a consequence of the client's depressive symptoms rather than the root cause in this scenario.

3. A client with Bulimia and depression who is taking phenelzine (Nardil) 90 mg daily is admitted to an acute care hospital for uncontrolled hypertension. What dietary choices should the RN instruct the client to avoid?

• A. Pan-seared catfish.
• B. Pepperoni pizza.
• C. Deep-fried shrimp.
• D. Beef strips with gravy.

Correct answer: D

Rationale: When a client is taking MAO inhibitors like phenelzine, foods containing tyramine should be avoided. Tyramine-rich foods can interact with MAO inhibitors and lead to a hypertensive crisis. Beef strips with gravy contain tyramine, making choice D the correct answer. Choices A, B, and C do not contain high levels of tyramine and are not specifically contraindicated with MAO inhibitors.

4. A client who is being treated with lithium carbonate for bipolar disorder develops diarrhea, vomiting, and drowsiness. What action should the nurse take?

• A. Notify the healthcare provider immediately and prepare for administration of an antidote.
• B. Hold the medication and refrain from administering additional amounts of the drug.
• C. Record the symptoms as potential signs of lithium toxicity and hold further medication.
• D. Notify the healthcare provider of the symptoms for evaluation before the next administration of the drug.

Correct answer: A

Rationale: Diarrhea, vomiting, and drowsiness in a client being treated with lithium carbonate for bipolar disorder may indicate lithium toxicity. The nurse should promptly notify the healthcare provider to ensure immediate medical intervention. The correct action is to prepare for the administration of an antidote if necessary. Holding the medication (Choice B) without immediate intervention could delay necessary treatment. Recording the symptoms as potential signs of lithium toxicity (Choice C) is more appropriate than considering them as normal side effects but does not emphasize the urgency of immediate action. Notifying the healthcare provider before the next administration of the drug (Choice D) may delay urgent intervention required for lithium toxicity.

5. The mental health team is determining treatment options for a male patient experiencing psychotic symptoms. Which question(s) should the team answer to determine whether a community outpatient or inpatient setting is most appropriate? Select all that apply.

• A. Is the patient expressing suicidal thoughts?
• B. Does the patient have experiences with either community or inpatient mental healthcare facilities?
• C. Does the patient require a therapeutic environment to support the management of psychotic symptoms?
• D. Is the patient experiencing delusions or hallucinations?

Correct answer: B

Rationale: To determine whether a community outpatient or inpatient setting is most appropriate for a patient experiencing psychotic symptoms, it is crucial to consider if the patient has had experiences with either community or inpatient mental healthcare facilities. This helps assess the familiarity and comfort level of the patient in those settings, aiding in decision-making regarding the level of care needed. Choice A, addressing suicidal thoughts, is important for risk assessment and safety planning but does not directly help in determining the setting appropriateness between community outpatient or inpatient care. Choice C, about the need for a therapeutic environment, is significant but does not specifically assist in deciding between outpatient or inpatient care. Choice D, related to delusions or hallucinations, is relevant in assessing the symptomatology but does not directly guide the choice between community outpatient or inpatient care.

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