Nursing Elites

1. During the working phase of a therapeutic relationship, a client with methamphetamine use disorder displays transference behavior. Which action by the client indicates transference behavior?

• A. The client asks the nurse if they will go out to dinner together
• B. The client accuses the nurse of being controlling just like an ex-partner
• C. The client reminds the nurse of a friend who died from substance toxicity
• D. The client becomes angry and threatens to engage in self-harm

Correct answer: B

Rationale: Transference occurs when a client projects feelings, often unconscious, onto the nurse that are associated with significant figures in their past or present life. In this scenario, the client accusing the nurse of being controlling like an ex-partner demonstrates transference behavior by attributing characteristics of someone from their past onto the nurse. Choices A, C, and D do not reflect transference behavior. Choice A involves a social invitation, which is not necessarily transference. Choice C is more related to countertransference as it triggers memories in the nurse, not the client. Choice D describes aggressive behavior and self-harm threats, which are not indicative of transference.

2. In dissociative identity disorder, a patient exhibits different personalities, each with distinct behaviors and memories. The nurse recognizes that this fragmentation of identity serves as a coping mechanism for:

• A. Current stressors
• B. Developmental issues
• C. Traumatic experiences
• D. Family dynamics

Correct answer: C

Rationale: In dissociative identity disorder, the fragmentation of identity serves as a coping mechanism for traumatic experiences. Individuals may develop different identities to help them manage and cope with overwhelming and traumatic events from their past. These distinct personalities often emerge as a way to protect the individual from the emotional pain associated with their traumatic experiences. Choices A, B, and D are incorrect because dissociative identity disorder is primarily associated with coping mechanisms related to past traumatic experiences, rather than current stressors, developmental issues, or family dynamics.

3. A client who is at risk for suicide following their partner’s death is speaking with a nurse. Which of the following statements should the nurse make?

• A. “I feel very sorry for the loneliness you must be experiencing.”
• B. “Suicide is not the appropriate way to cope with loss.”
• C. “Losing someone close to you must be very upsetting.”
• D. “I know how difficult it is to lose a loved one.”

Correct answer: C

Rationale: When a client is at risk for suicide, it is crucial for the nurse to acknowledge the emotional impact of losing a loved one without downplaying or judging their feelings. Statement C demonstrates empathy and understanding without making assumptions or providing unsolicited advice, making it the most appropriate response in this situation. Choice A focuses more on the nurse's feelings rather than the client's, which might not effectively address the client's emotional state. Choice B is judgmental and dismissive, which could further isolate the client. Choice D, although empathetic, shifts the focus to the nurse's experience rather than validating the client's feelings.

4. What is the priority intervention for a patient admitted for an overdose of sedatives and diagnosed with dissociative identity disorder?

• A. Conducting a suicide assessment
• B. Arranging for placement in a group home
• C. Providing a low-stimulation environment
• D. Establishing trust and rapport

Correct answer: A

Rationale: Conducting a suicide assessment is the priority intervention for a patient admitted for an overdose of sedatives and diagnosed with dissociative identity disorder. In this scenario, the immediate concern is to assess the risk of harm to the patient's life. It is crucial to determine if the overdose was intentional and if the patient has suicidal ideation or intent. Arranging for placement in a group home (choice B) may be necessary at a later stage depending on the patient's needs, but it is not the priority in this urgent situation. Providing a low-stimulation environment (choice C) and establishing trust and rapport (choice D) are important aspects of care but addressing the immediate risk of suicide takes precedence in this case.

5. During a panic attack, what is the most appropriate nursing intervention?

• A. Encourage the patient to talk about their feelings.
• B. Provide a quiet, non-stimulating environment.
• C. Administer prescribed medication immediately.
• D. Teach the patient relaxation techniques.

Correct answer: B

Rationale: During a panic attack, a quiet, non-stimulating environment is the most appropriate nursing intervention. This helps reduce stimuli that may exacerbate the panic attack and allows the individual to focus on calming down. Encouraging the patient to talk about their feelings may not be effective during an acute panic attack as the focus should be on reducing stimuli. Administering medication should follow healthcare provider's orders and may not be the initial intervention. Teaching relaxation techniques is beneficial in managing anxiety but may not be the priority during the acute phase of a panic attack where reducing stimuli is crucial.

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