Nursing Elites

1. A healthcare provider is caring for a client diagnosed with schizophrenia. Which intervention is most appropriate to address the client's delusions?

• A. Challenge the client's delusions directly.
• B. Provide evidence to disprove the delusions.
• C. Acknowledge the client's feelings without reinforcing the delusions.
• D. Ignore the client's delusions.

Correct answer: C

Rationale: When caring for a client with schizophrenia experiencing delusions, the most appropriate intervention is to acknowledge the client's feelings without reinforcing the delusions. This approach helps maintain trust and communication, fostering a therapeutic relationship. Challenging the delusions directly can lead to increased distress and resistance from the client. Providing evidence to disprove the delusions may not be effective due to the deeply ingrained nature of the client's beliefs. Ignoring the delusions may make the client feel dismissed or unheard, which can hinder the therapeutic process.

2. When should healthcare professionals be most alert to the possibility of communication errors resulting in harm to the patient?

• A. Change of shift reports
• B. Admission interviews
• C. One-to-one conversations with patients
• D. Conversations with patient families

Correct answer: A

Rationale: Healthcare professionals should be most alert to the possibility of communication errors resulting in harm to the patient during change of shift reports. This is a critical time when information is transferred between healthcare providers, and any errors in communication during this handover can lead to adverse outcomes for the patient.

3. In the treatment of generalized anxiety disorder (GAD), what medication is frequently prescribed as a first-line treatment?

• A. Clonazepam
• B. Buspirone
• C. Propranolol
• D. Hydroxyzine

Correct answer: B

Rationale: Buspirone is often chosen as a first-line treatment for generalized anxiety disorder (GAD) due to its efficacy and favorable side effect profile. Unlike benzodiazepines such as clonazepam (A), buspirone does not carry the risk of tolerance, dependence, or withdrawal symptoms, making it a preferred choice. While propranolol (C) and hydroxyzine (D) are sometimes used for anxiety, they are not typically considered first-line treatments for GAD.

4. Which therapeutic approach is most effective for managing borderline personality disorder?

• A. Dialectical behavior therapy
• B. Cognitive-behavioral therapy
• C. Psychoanalysis
• D. Supportive therapy

Correct answer: A

Rationale: Dialectical behavior therapy (DBT) is considered the most effective therapeutic approach for managing borderline personality disorder. DBT is a specialized form of cognitive-behavioral therapy that focuses on providing skills to cope with intense emotions, improve relationships, and regulate behavior. It has been extensively studied and shown to be effective in reducing self-harm, suicidal behaviors, and improving overall functioning in individuals with borderline personality disorder. Cognitive-behavioral therapy (Choice B) is a common and effective treatment for many mental health conditions but is not as specifically tailored to address the core symptoms of borderline personality disorder as DBT. Psychoanalysis (Choice C) is a more intensive and long-term therapy that focuses on exploring unconscious patterns and early life experiences, which may not be as practical or effective for the impulsive and emotional dysregulation seen in borderline personality disorder. Supportive therapy (Choice D) provides emotional support but lacks the structured skills training and strategies that are essential in managing borderline personality disorder.

5. A client has a history of excessive drinking, which has led to multiple arrests for driving under the influence (DUI). The client states, 'I work hard to provide for my family. I don't see why I can't drink to relax.' The nurse recognizes the use of which defense mechanism?

• A. Projection
• B. Rationalization
• C. Regression
• D. Sublimation

Correct answer: B

Rationale: The correct answer is Rationalization. The client is using rationalization as a defense mechanism by justifying their excessive drinking as a way to relax due to working hard to provide for their family. Rationalization involves creating logical excuses to justify unacceptable feelings or behaviors. Projection involves attributing one's unacceptable feelings or thoughts to others. Regression is reverting to an earlier stage of development in the face of unacceptable thoughts or impulses. Sublimation is the channeling of unacceptable impulses into socially acceptable activities.

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