Nursing Elites

1. A client in an acute mental health facility is being discharged and requires supervision due to a severe mental illness. The client’s partner works all day but is home by late afternoon. Which of the following strategies should the nurse suggest for follow-up care?

• A. Receiving daily care from a home health aide
• B. Having a weekly visit from a nurse case worker
• C. Attending a partial hospitalization program
• D. Visiting a community mental health center on a daily basis

Correct answer: C

Rationale: For clients requiring supervision due to severe mental illness, attending a partial hospitalization program provides structured care and support while allowing the client to return home in the evenings, making it a suitable option for follow-up care. The other choices are less appropriate: A home health aide may not provide the necessary level of care and supervision, a weekly visit from a nurse case worker may not be sufficient for the client's needs, and visiting a community mental health center on a daily basis may not offer the structured support required for someone with a severe mental illness.

2. When developing a care plan for a patient with generalized anxiety disorder (GAD), which long-term goal is most appropriate?

• A. The patient will experience no episodes of anxiety.
• B. The patient will recognize and modify anxiety-provoking thoughts.
• C. The patient will avoid situations that cause anxiety.
• D. The patient will take medication as prescribed.

Correct answer: B

Rationale: The most appropriate long-term goal for managing generalized anxiety disorder is for the patient to recognize and modify anxiety-provoking thoughts. By addressing and modifying these thoughts, the patient can develop coping mechanisms and strategies to manage their anxiety more effectively in the long term. Choices A and C are not ideal long-term goals as complete elimination of anxiety episodes or avoidance of anxiety-provoking situations may not be realistic or sustainable. Choice D focuses solely on medication adherence, which is important but does not address the core cognitive-behavioral aspects of managing anxiety in GAD.

3. A patient diagnosed with dissociative identity disorder has been undergoing therapy for several months. Which outcome indicates that the patient is progressing in therapy?

• A. The patient has developed a strong therapeutic relationship with the therapist.
• B. The patient’s different personalities are beginning to merge.
• C. The patient is able to recall traumatic events without dissociating.
• D. The patient reports fewer gaps in memory.

Correct answer: B

Rationale: In dissociative identity disorder, the merging of different personalities is a crucial indicator of progress in therapy. As the different identities merge, it signifies that the patient is integrating fragmented aspects of their self, leading to a more cohesive sense of identity and a reduction in dissociative symptoms. This process is a significant therapeutic milestone in the treatment of dissociative identity disorder as it promotes internal cohesion and decreases internal conflict. Choices A, C, and D are incorrect because while developing a strong therapeutic relationship, recalling traumatic events without dissociating, and reporting fewer gaps in memory are important aspects of therapy, the merging of different personalities is specifically indicative of substantial progress in treating dissociative identity disorder.

4. A patient with obsessive-compulsive disorder (OCD) frequently washes their hands. Which nursing intervention is most appropriate?

• A. Allow the patient to wash their hands, then gradually limit the time spent on this behavior.
• B. Discourage the patient from discussing their obsessions.
• C. Encourage the patient to suppress their compulsive behaviors.
• D. Avoid setting limits on the patient's compulsive behaviors.

Correct answer: A

Rationale: In managing a patient with OCD who frequently washes their hands, it is important to understand that compulsive behaviors provide temporary relief from anxiety. Allowing the patient to engage in their rituals initially and then gradually setting limits on the time spent can help them gain control over their compulsions. This approach supports the patient without causing undue distress, ultimately assisting in managing OCD symptoms effectively. Choice B is incorrect as discouraging the patient from discussing their obsessions can hinder therapeutic communication and understanding of their condition. Choice C is wrong because encouraging the patient to suppress their compulsive behaviors may increase their anxiety and lead to worsening symptoms. Choice D is also incorrect as avoiding setting limits on the patient's compulsive behaviors does not help the patient in gaining control over their OCD symptoms.

5. After Natasha's husband passed away two months ago, 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: It is common for major depressive disorder to be triggered by significant life events, such as the sudden loss of a loved one. Therefore, Nadia's statement that 'Depression often begins after a major loss' is correct. Bereavement and major depressive disorder are related but distinct conditions, and while mourning can be intense, it is generally considered a normal response to loss. Antidepressant medications can be beneficial in treating depression, including cases triggered by a significant loss.

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