Nursing Elites

1. When developing a care plan for a patient with borderline personality disorder, which intervention should be included to address self-harm behaviors?

• A. Encouraging the patient to keep a journal of their thoughts and feelings.
• B. Setting clear and consistent boundaries with the patient.
• C. Providing the patient with coping skills to manage their emotions.
• D. Developing a safety plan with the patient.

Correct answer: D

Rationale: Developing a safety plan with the patient is crucial when addressing self-harm behaviors in individuals with borderline personality disorder. This intervention helps outline steps to take during a crisis, identifies triggers, and provides strategies to prevent self-harm incidents. It involves collaboratively creating a plan between the patient and the healthcare team to ensure a structured and supportive approach to managing potentially dangerous situations.

2. A patient with major depressive disorder has been prescribed sertraline (Zoloft). Which statement by the patient indicates a need for further teaching?

• A. I should take my medication with food to avoid stomach upset.
• B. I should avoid alcohol while taking this medication.
• C. I can stop taking my medication once I feel better.
• D. I might experience some improvement in mood within a few weeks.

Correct answer: C

Rationale: Choice C is the correct answer. It is crucial for patients to understand that they should not stop taking their medication once they feel better. Discontinuing antidepressants abruptly can lead to a relapse of depressive symptoms. Patients should continue taking their medication as prescribed by their healthcare provider, even if they start feeling better, to ensure the best outcomes in managing major depressive disorder. Choices A, B, and D are all accurate statements. Taking medication with food can help reduce stomach upset, avoiding alcohol is essential while on sertraline to prevent interactions, and experiencing some improvement in mood within a few weeks is a common expectation when starting an antidepressant like sertraline.

3. What is an important aspect of patient education regarding buspirone when prescribed for generalized anxiety disorder (GAD)?

• A. Buspirone is an as-needed medication for anxiety.
• B. Buspirone has a high risk of addiction and dependence.
• C. Buspirone may not become effective until 2-4 weeks after starting the medication.
• D. Buspirone should be taken with food to increase absorption.

Correct answer: C

Rationale: The correct answer is C. When educating a patient about buspirone for generalized anxiety disorder, it is crucial to highlight that buspirone may take 2-4 weeks to become effective. Patients need to be aware of this delayed onset of action to manage their expectations and continue the medication as prescribed. This information helps patients understand that they may not experience immediate relief and should not discontinue the medication prematurely. Choices A, B, and D are incorrect because buspirone is typically taken regularly, not as-needed, it has a lower risk of addiction compared to other anxiety medications, and it does not need to be taken with food for increased absorption.

4. Which nursing response provides accurate information to discuss with the female patient diagnosed with bipolar disorder and her support system?

• A. Remember that alcohol and caffeine can trigger a relapse of your symptoms.
• B. Antidepressant therapy should be carefully monitored due to the risk of a manic episode in bipolar disorder.
• C. It’s crucial to inform your healthcare provider promptly if you experience sleep disturbances.
• D. Are your family members prepared to play an active role in helping manage this disorder?

Correct answer: A

Rationale: Choice A is the correct answer as it emphasizes the importance of avoiding triggers like alcohol and caffeine that can lead to symptom relapse in patients with bipolar disorder. Educating the patient and their support system about these triggers is essential for managing the condition effectively and preventing exacerbations of symptoms. Choice B is incorrect as it overly focuses on antidepressant therapy, which is not the primary concern related to triggers for symptom relapse. Choice C, while important, does not directly address triggers for symptom relapse in bipolar disorder. Choice D is also relevant but does not provide immediate information on managing triggers for symptom relapse.

5. James is a 42-year-old patient with schizophrenia. He approaches you as you arrive for the day shift and anxiously reports, ‘Last night, demons came to my room and tried to rape me.’ Which response would be most therapeutic?

• A. There are no such things as demons. What you saw were hallucinations.
• B. It is not possible for anyone to enter your room at night. You are safe here.
• C. You seem very upset. Please tell me more about what you experienced last night.
• D. That must have been very frightening, but we’ll check on you at night and you’ll be safe.

Correct answer: C

Rationale: Choice C is the most therapeutic response as it acknowledges the patient’s feelings, shows empathy, and encourages further expression of his experiences. By actively listening and inviting the patient to share more details, the healthcare provider provides a supportive environment that can help the patient feel understood and validated. Option A dismisses the patient's experience and can make him feel unheard. Option B denies the patient's reality and can increase his distress. Option D, while offering reassurance, does not address the patient's emotional state or encourage further communication.

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