Nursing Elites

1. A middle-aged adult with major depressive disorder suffers from psychomotor retardation, hypersomnia, and lack of motivation. Which intervention is likely to be most effective in returning this client to a normal level of functioning?

• A. Provide education on methods to enhance sleep.
• B. Teach the client to develop a plan for daily structured activities.
• C. Suggest that the client develop a list of pleasurable activities.
• D. Encourage the client to exercise.

Correct answer: B

Rationale: Teaching the client to develop a plan for daily structured activities is the most effective intervention in this scenario. This intervention helps address psychomotor retardation and enhances motivation and functioning. By structuring the client's day, it can provide a sense of purpose, routine, and accomplishment. Option A, providing education on methods to enhance sleep, may be helpful but does not directly address the client's overall functioning. Option C, suggesting the client develop a list of pleasurable activities, may provide temporary relief but may not address the core symptoms of major depressive disorder. Option D, encouraging the client to exercise, can be beneficial, but in this case, addressing the lack of structure and motivation through a daily plan is more appropriate.

2. To evaluate the effectiveness of cognitive-behavioral techniques, which client outcomes should the nurse include in the plan of care?

• A. Relates insights into problematic relationships
• B. Demonstrates a healthy relationship with her husband
• C. Describes how the family can resolve problems
• D. Changes thought patterns related to problem-solving

Correct answer: D

Rationale: The correct answer is D. Cognitive-behavioral therapy focuses on changing thought patterns by guiding the client to engage in problem-solving strategies to address the current situation. This approach helps individuals modify negative thinking patterns and develop more adaptive ways to cope with challenges. Choices A, B, and C are incorrect because while they may be important aspects to consider in therapy, the primary focus in cognitive-behavioral therapy is on identifying and changing negative thought patterns rather than exploring relationships or family problem-solving skills.

3. After surgery, a male client with antisocial personality disorder frequently requests a specific nurse be assigned to his care and becomes belligerent when another nurse is assigned. What action should the charge nurse implement?

• A. Reassure the client that his request will be met whenever possible.
• B. Advise the client that assignments are not based on client requests.
• C. Ask the client to explain why he constantly requests the nurse.
• D. Encourage the client to verbalize his feelings about the nurse.

Correct answer: B

Rationale: The correct action for the charge nurse is to advise the client that assignments are not based on client requests. Clients with antisocial personality disorder may attempt to manipulate situations to their advantage. By setting clear boundaries and explaining that assignments are not based on client preferences, the nurse helps prevent manipulation and maintains a professional approach to care. Reassuring the client about his requests (Choice A) may encourage the inappropriate behavior to continue. Asking the client to explain his requests (Choice C) may further fuel the manipulation by providing an opportunity for the client to justify his actions. Encouraging the client to verbalize feelings (Choice D) does not address the underlying issue of manipulating the assignment process and may inadvertently reinforce the behavior.

4. A client who has agoraphobia (a fear of crowds) is beginning desensitization with the therapist, and the RN is reinforcing the process. Which intervention has the highest priority for this client’s plan of care?

• A. Encourage substitution of positive thoughts for negative ones.
• B. Establish trust by providing a calm, safe environment.
• C. Progressively expose the client to larger crowds.
• D. Encourage deep breathing when anxiety escalates in a crowd.

Correct answer: B

Rationale: Establishing trust and providing a calm, safe environment is crucial when working with clients with agoraphobia undergoing desensitization therapy. This approach helps build a foundation of safety and security, allowing the client to feel more comfortable and supported during the exposure process. Encouraging positive thoughts (choice A) is important, but ensuring a safe environment takes precedence. Progressively exposing the client to larger crowds (choice C) should be done gradually and in a controlled manner; rushing this process can be overwhelming and counterproductive. Encouraging deep breathing (choice D) is a helpful coping mechanism, but creating a safe and trusting environment is the initial priority to facilitate successful desensitization therapy.

5. The healthcare professional is preparing medications for a client with bipolar disorder and notices that the antipsychotic medication was discontinued several days ago. Which medication should also be discontinued?

• A. Alprazolam (Xanax)
• B. Benztropine (Cogentin)
• C. Magnesium (Milk of Magnesia)
• D. Lithium (Lithotabs)

Correct answer: B

Rationale: When an antipsychotic medication is discontinued, medications like Benztropine (Cogentin), which are given to reduce extrapyramidal side effects associated with traditional antipsychotic medications, should also be discontinued. Alprazolam (Xanax) is not directly related to antipsychotic medication use in this context. Magnesium (Milk of Magnesia) is a laxative and not typically indicated for bipolar disorder. Lithium (Lithotabs) is a mood stabilizer commonly used in bipolar disorder, and its discontinuation should be carefully managed under the guidance of a healthcare provider to prevent relapse of symptoms.

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