Nursing Elites

1. A patient is being discharged with a prescription for an antidepressant for their depression. Which instruction is most important?

• A. Take the medication with food to prevent stomach upset.
• B. Refrain from driving until you understand the effects of the medication.
• C. Do not discontinue the medication suddenly.
• D. Avoid alcohol consumption while taking this medication.

Correct answer: C

Rationale: The most critical instruction is to not discontinue the antidepressant medication suddenly. Abrupt discontinuation can lead to withdrawal symptoms and potentially trigger a relapse of depression. Options A, B, and D are important but not as crucial as ensuring the patient follows the prescribed regimen and consults with a healthcare provider before making any changes to the medication routine.

2. Which therapeutic communication technique involves restating the patient's message to ensure understanding?

• A. Clarification
• B. Reflection
• C. Summarization
• D. Paraphrasing

Correct answer: D

Rationale: Paraphrasing is the correct therapeutic communication technique where the nurse restates the patient's message in their own words to confirm understanding. This technique helps in validating the patient's feelings and ensuring that both parties are in agreement, leading to effective communication and rapport building. Choice A, 'Clarification,' involves seeking further information to enhance understanding rather than restating the message. Choice B, 'Reflection,' involves echoing the patient's feelings to show empathy rather than restating the message. Choice C, 'Summarization,' involves condensing the main points of a conversation rather than restating a specific message.

3. 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.

4. A 32-year-old female patient is diagnosed with generalized anxiety disorder (GAD). Which behavior would the nurse expect to observe?

• A. Complains of persistent and excessive worry.
• B. Frequently fidgets and has difficulty sitting still.
• C. Exhibits ritualistic behaviors.
• D. Reports periods of derealization.

Correct answer: A

Rationale: In generalized anxiety disorder (GAD), individuals often experience persistent and excessive worry about various aspects of their life. This worry is difficult to control and is disproportionate to the actual source of concern. The other options describe behaviors more commonly associated with other anxiety disorders like social anxiety disorder (frequent fidgeting and difficulty sitting still), obsessive-compulsive disorder (ritualistic behaviors), and depersonalization/derealization disorder (periods of derealization). Therefore, the correct behavior to expect in a patient with GAD is persistent and excessive worry.

5. 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.

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