Nursing Elites

1. A nurse is planning care for several clients attending community-based mental health programs. Which of the following clients should the nurse visit first?

• A. A client who received a burn on the arm while using a hot iron at home
• B. A client who requests a change of antipsychotic medication due to new adverse effects
• C. A client who reports hearing a voice saying that life is not worth living anymore
• D. A client who tells the nurse about experiencing manifestations of severe anxiety before and during a job interview

Correct answer: C

Rationale: The nurse should visit the client who reports hearing a voice saying that life is not worth living anymore first. This statement indicates potential suicidal ideation, which requires immediate intervention to ensure the client's safety. Choices A, B, and D do not present an immediate threat to the client's life. While burns, adverse effects of medication, and severe anxiety are important concerns, they do not pose an immediate risk of self-harm or suicide.

2. Which assessment question will provide information regarding the effects of a woman’s circadian rhythms on her quality of life?

• A. How much sleep do you usually get each night?
• B. Does your heart ever seem to skip a beat?
• C. When was the last time you had a fever?
• D. Do you have problems urinating?

Correct answer: A

Rationale: The correct answer is A: 'How much sleep do you usually get each night?' Asking about sleep patterns is essential to understand the impact of circadian rhythms on an individual's quality of life. Adequate sleep is closely linked to circadian rhythms, and disturbances in sleep patterns can significantly affect a person's well-being and daily functioning. Choices B, C, and D are not directly related to circadian rhythms and would not provide information specifically about how circadian rhythms affect quality of life.

3. A client with anxiety disorder is scheduled to begin classical psychoanalysis. Which client statement indicates an understanding of this form of therapy?

• A. “Even if my anxiety improves, I will need to continue this therapy for 6 weeks”
• B. “The therapist will focus on my past relationships during our sessions”
• C. “Psychoanalysis will help me reduce my anxiety by changing my behaviors”
• D. “This therapy will address my conscious feelings about stressful experiences”

Correct answer: B

Rationale: In classical psychoanalysis, the therapist delves into the client's past relationships, childhood experiences, and unconscious thoughts to uncover underlying issues contributing to the client's current symptoms. Understanding that the therapist will focus on past relationships aligns with the core principles of classical psychoanalysis. Choice A is incorrect because the duration of classical psychoanalysis is typically longer than 6 weeks. Choice C is incorrect as changing behaviors is more aligned with behavioral therapy than classical psychoanalysis. Choice D is incorrect as classical psychoanalysis primarily focuses on unconscious thoughts rather than conscious feelings about stressful experiences.

4. 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: The most therapeutic response acknowledges the patient's emotional state and invites further discussion about their experience. By saying, 'You seem very upset. Please tell me more about what you experienced last night,' the nurse shows empathy and openness, providing a supportive environment for the patient to express their feelings and perceptions.

5. A patient with social anxiety disorder is starting cognitive-behavioral therapy (CBT). Which statement by the nurse best explains the purpose of this therapy?

• A. CBT will help you understand and change your thought patterns.
• B. CBT will focus on exploring your childhood experiences.
• C. CBT will teach you relaxation techniques to use in social situations.
• D. CBT will help you avoid situations that cause anxiety.

Correct answer: A

Rationale: Cognitive-behavioral therapy (CBT) is a structured, short-term psychotherapy that aims to help patients identify and change negative thought patterns and behaviors associated with anxiety. By understanding and altering these patterns, individuals can learn to manage and alleviate their symptoms effectively. Choice A is the correct answer as it accurately describes the purpose of CBT for social anxiety disorder. Choices B, C, and D are incorrect. B is incorrect because while childhood experiences may be explored, the primary focus of CBT is on thought patterns and behaviors in the present. C is incorrect because although relaxation techniques may be a component of CBT, the primary goal is not just to teach relaxation but to address underlying cognitive and behavioral patterns. D is incorrect because the goal of CBT is not avoidance but rather to confront and manage anxiety-provoking situations.

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