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. What is a priority intervention for a patient with severe anxiety?

• A. Encouraging the patient to discuss their feelings in detail.
• B. Providing a calm and quiet environment.
• C. Encouraging the patient to participate in group activities.
• D. Providing detailed information about their treatment plan.

Correct answer: B

Rationale: When dealing with a patient experiencing severe anxiety, providing a calm and quiet environment is a priority intervention. This approach helps reduce stimuli and anxiety levels, creating a more soothing atmosphere for the individual. Encouraging the patient to discuss their feelings in detail or participate in group activities may be beneficial in certain situations, but establishing a peaceful setting takes precedence when managing severe anxiety. Providing detailed information about their treatment plan, although important, may not be the immediate priority when the patient is in a state of severe anxiety and needs a calming environment first.

3. A client tells a nurse, 'Don’t tell anyone, but I hid a sharp knife under my mattress to protect myself from my threatening roommate.' Which of the following actions should the nurse take?

• A. Keep the client’s communication confidential, but talk to the client daily using therapeutic communication to convince them to admit to hiding the knife
• B. Keep the client’s communication confidential, but watch the client and their roommate closely
• C. Tell the client that this must be reported to the health care team because it concerns the health and safety of the client and others
• D. Report the incident to the health care team but do not inform the client of the intention to do so

Correct answer: C

Rationale: In this scenario, the nurse must prioritize the safety of the client and others. The client's disclosure of hiding a sharp knife under the mattress poses a significant risk. It is crucial for the nurse to inform the health care team about this situation to ensure immediate intervention and prevent any harm. Confidentiality is important in nursing care, but in cases where there is a clear threat to safety, the duty to protect overrides the duty of confidentiality. Reporting the incident to the health care team is essential to address the safety concerns and provide appropriate support and intervention for the client. Choices A and B are incorrect because while confidentiality is important, the immediate safety concern outweighs keeping the client's communication confidential or simply monitoring the situation. Choice D is incorrect as it does not involve informing the client, which can impact the therapeutic relationship and trust between the nurse and the client.

4. A healthcare provider is developing a care plan for a patient with posttraumatic stress disorder (PTSD). Which intervention should be included to help the patient manage flashbacks?

• A. Encouraging the patient to confront the trauma directly.
• B. Teaching the patient grounding techniques.
• C. Encouraging the patient to use relaxation techniques.
• D. Helping the patient develop a safety plan.

Correct answer: B

Rationale: Teaching grounding techniques is an effective intervention for managing flashbacks in patients with PTSD. Grounding techniques help individuals focus on the present moment, which can reduce the intensity of flashbacks and promote a sense of safety and stability.

5. When discharging a patient with schizophrenia on risperidone, what is an important point to include in the discharge teaching?

• A. Avoiding foods high in tyramine is essential.
• B. Getting blood levels checked regularly is necessary.
• C. Being cautious when driving due to possible drowsiness is crucial.
• D. Taking this medication on an as-needed basis is recommended.

Correct answer: B

Rationale: Regular monitoring of blood levels is crucial for patients taking risperidone to ensure the medication is at therapeutic levels and to prevent potential toxicity. This monitoring helps healthcare providers adjust the dosage as needed to optimize treatment outcomes and minimize adverse effects.

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