Nursing Elites

1. A fourth-grade student teases and makes jokes about a cute girl in his class. This behavior should be identified by a professional as indicative of which defense mechanism?

• A. Displacement
• B. Projection
• C. Reaction formation
• D. Sublimation

Correct answer: C

Rationale: The professional should identify that the student is using reaction formation as a defense mechanism. Reaction formation involves expressing opposite thoughts or behaviors to prevent undesirable thoughts from being expressed. In this scenario, the student's teasing and joking behavior towards the girl can be seen as a way to cover up or mask his true feelings or desires towards her. Displacement involves redirecting emotions from the original source to a substitute target; Projection involves attributing one's undesirable feelings to others; Sublimation involves channeling unacceptable impulses into socially acceptable activities. Therefore, in this case, the student's behavior aligns most closely with reaction formation.

2. A client has been diagnosed with major depressive disorder. Which is an appropriate short-term goal for the client?

• A. The client will report a decrease in depressive symptoms.
• B. The client will establish a sleep routine.
• C. The client will improve social interactions.
• D. The client will set realistic goals for the future.

Correct answer: A

Rationale: Setting a goal for the client to report a decrease in depressive symptoms is appropriate as it is specific, measurable, and achievable in the short term. Monitoring changes in depressive symptoms provides valuable feedback on the effectiveness of the treatment plan. While establishing a sleep routine, improving social interactions, and setting realistic goals for the future are important aspects of recovery, they are more suitable as intermediate or long-term goals. In the context of short-term goals, focusing on symptom reduction can provide immediate feedback on the client's progress and help adjust the treatment plan accordingly.

3. Why is it important to establish a contract with a client with an eating disorder at the beginning of treatment?

• A. The client and healthcare provider form a partnership that is challenging for the family to disrupt.
• B. A collaborative approach to treatment planning ensures that both physical and emotional needs will be addressed.
• C. Involving the client in decision-making enhances the feeling of control and fosters cooperation.
• D. Permission for refeeding is crucial as it can have adverse effects.

Correct answer: C

Rationale: Establishing a contract with a client with an eating disorder at the start of treatment is crucial to involve the client in decision-making processes. By engaging the client in decision-making, it enhances their sense of control over their treatment, which can lead to increased cooperation and better treatment outcomes. This collaborative approach empowers the client and fosters a therapeutic alliance between the client and the healthcare provider, rather than excluding the family or causing disruptions. It focuses on addressing both the physical and emotional needs of the client, ensuring a comprehensive treatment plan.

4. Kyle, a patient with schizophrenia, began taking the first-generation antipsychotic haloperidol (Haldol) last week. One day you find him sitting very stiffly and not moving. He is diaphoretic, and when you ask if he is okay, he seems unable to respond verbally. His vital signs are: BP 170/100, P 110, T 104.2°F. What is the priority nursing intervention? Select one that does not apply.

• A. Hold his medication and contact his prescriber.
• B. Wipe him with a washcloth wet with cold water or alcohol.
• C. Administer a medication such as benztropine IM to correct this dystonic reaction.
• D. Reassure him that although there is no treatment for his tardive dyskinesia, it will pass.

Correct answer: C

Rationale: The patient's symptoms, including stiffness, diaphoresis, inability to respond verbally, and vital sign abnormalities, are indicative of neuroleptic malignant syndrome (NMS), a serious and potentially life-threatening side effect of antipsychotic medications. Administering a medication such as benztropine intramuscularly is the priority to address the dystonic reaction associated with NMS. This intervention can help alleviate symptoms and prevent further complications. Holding the medication and contacting the prescriber may be necessary but addressing the acute symptoms takes precedence. Wiping the patient with a cold washcloth or alcohol would not address the underlying medical emergency. Reassuring the patient about tardive dyskinesia is irrelevant and not the immediate concern in this scenario.

5. Which of the following statements should a healthcare provider recognize as true about defense mechanisms? Select all that apply.

• A. They are employed when there is a threat to biological or psychological integrity.
• B. They are controlled by the id and deal with primal urges.
• C. They are used in an effort to increase anxiety.
• D. They are protective devices for the superego.

Correct answer: A

Rationale: Defense mechanisms are employed by the ego, not the id or superego, in response to threats to biological or psychological integrity. They aim to relieve anxiety, not increase it. By redirecting focus, they help manage mild to moderate anxiety and are often self-deceptive in nature.

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