Nursing Elites

1. A patient with obsessive-compulsive disorder (OCD) is under the care of a nurse. Which intervention is most appropriate?

• A. Encourage the patient to suppress their compulsive behaviors.
• B. Allow the patient to perform their rituals, then gradually limit the time spent on these rituals.
• C. Discourage the patient from discussing their obsessions.
• D. Avoid setting limits on the patient’s compulsive behaviors.

Correct answer: B

Rationale: In managing a patient with OCD, it is crucial to allow them to perform their rituals while gradually limiting the time spent on these rituals. This approach helps the patient feel supported while working towards reducing the compulsive behaviors. Choice A is incorrect because suppressing compulsive behaviors can increase anxiety and distress. Choice C is inappropriate as discussing obsessions is part of therapy. Choice D is not recommended as setting limits on compulsive behaviors is essential for treatment.

2. What assessment findings would indicate lithium toxicity in a patient hospitalized for an acute manic episode?

• A. Shortness of breath, gastrointestinal distress, chronic cough
• B. Ataxia, severe hypotension, large volume of dilute urine
• C. Gastrointestinal distress, thirst, nystagmus
• D. Electroencephalographic changes, chest pain, dizziness

Correct answer: B

Rationale: In a patient suspected of lithium toxicity, the presence of ataxia, severe hypotension, and a large volume of dilute urine are key assessment findings. Ataxia is a sign of central nervous system involvement, severe hypotension indicates cardiovascular effects, and a large volume of dilute urine suggests renal impairment, all of which are commonly seen in severe lithium toxicity. Options A, C, and D do not align with typical signs of lithium toxicity.

3. Which symptom is most indicative of posttraumatic stress disorder (PTSD)?

• A. Persistent low mood
• B. Frequent nightmares
• C. Hallucinations
• D. Compulsive behaviors

Correct answer: B

Rationale: Frequent nightmares are a hallmark symptom of posttraumatic stress disorder (PTSD). Individuals with PTSD often experience intrusive and distressing nightmares related to the traumatic event they have experienced. These nightmares can contribute to sleep disturbances and further exacerbate the individual's overall psychological distress. Persistent low mood, hallucinations, and compulsive behaviors are not specific symptoms of PTSD and are more commonly associated with other mental health conditions such as depression, psychotic disorders, and obsessive-compulsive disorder respectively.

4. When working with a patient diagnosed with posttraumatic stress disorder (PTSD), which therapeutic approach is most appropriate?

• A. Encouraging the patient to avoid discussing the traumatic event.
• B. Using exposure therapy to help the patient confront their fears.
• C. Advising the patient to focus on positive thoughts.
• D. Suggesting that the patient keep busy to distract from traumatic memories.

Correct answer: B

Rationale: Exposure therapy is an evidence-based treatment for PTSD that involves gradually exposing the patient to their traumatic memories in a safe and controlled environment. This approach helps individuals confront and process their fears, reducing the impact of the traumatic event over time. Avoiding discussing the trauma (choice A) may lead to avoidance behaviors and hinder recovery. Focusing on positive thoughts (choice C) may provide temporary relief but does not address the underlying trauma. Keeping busy to distract from memories (choice D) is a form of avoidance that does not help in processing the traumatic experiences. Therefore, using exposure therapy (choice B) is the most appropriate approach to effectively treat PTSD.

5. What must be considered when preparing the teaching plan for a patient diagnosed with bipolar disorder who is being prescribed lithium therapy?

• A. Caffeine and alcohol can affect lithium levels.
• B. Lithium should be taken with meals to avoid gastrointestinal distress.
• C. Regular blood tests are required to monitor lithium levels.
• D. Lithium can cause weight gain.

Correct answer: C

Rationale: When preparing a teaching plan for a patient prescribed lithium therapy for bipolar disorder, it is crucial to emphasize the need for regular blood tests to monitor lithium levels. Monitoring levels is essential to ensure the drug's effectiveness and to manage potential side effects. While factors like caffeine and alcohol intake, taking lithium with meals, and the risk of weight gain may be relevant considerations, the primary focus should be on the necessity of regular blood tests for effective management of lithium therapy. Therefore, option C is the correct choice as it addresses a critical aspect of lithium therapy management.

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