Nursing Elites

1. A patient with obsessive-compulsive disorder (OCD) frequently washes their hands. Which nursing intervention is most appropriate?

• A. Allow the patient to wash their hands, then gradually limit the time spent on this behavior.
• B. Discourage the patient from discussing their obsessions.
• C. Encourage the patient to suppress their compulsive behaviors.
• D. Avoid setting limits on the patient's compulsive behaviors.

Correct answer: A

Rationale: In managing a patient with OCD who frequently washes their hands, it is important to understand that compulsive behaviors provide temporary relief from anxiety. Allowing the patient to engage in their rituals initially and then gradually setting limits on the time spent can help them gain control over their compulsions. This approach supports the patient without causing undue distress, ultimately assisting in managing OCD symptoms effectively. Choice B is incorrect as discouraging the patient from discussing their obsessions can hinder therapeutic communication and understanding of their condition. Choice C is wrong because encouraging the patient to suppress their compulsive behaviors may increase their anxiety and lead to worsening symptoms. Choice D is also incorrect as avoiding setting limits on the patient's compulsive behaviors does not help the patient in gaining control over their OCD symptoms.

2. A patient diagnosed with dissociative identity disorder has been undergoing therapy for several months. Which outcome indicates that the patient is progressing in therapy?

• A. The patient has developed a strong therapeutic relationship with the therapist.
• B. The patient’s different personalities are beginning to merge.
• C. The patient is able to recall traumatic events without dissociating.
• D. The patient reports fewer gaps in memory.

Correct answer: B

Rationale: In dissociative identity disorder, the merging of different personalities is a crucial indicator of progress in therapy. As the different identities merge, it signifies that the patient is integrating fragmented aspects of their self, leading to a more cohesive sense of identity and a reduction in dissociative symptoms. This process is a significant therapeutic milestone in the treatment of dissociative identity disorder as it promotes internal cohesion and decreases internal conflict. Choices A, C, and D are incorrect because while developing a strong therapeutic relationship, recalling traumatic events without dissociating, and reporting fewer gaps in memory are important aspects of therapy, the merging of different personalities is specifically indicative of substantial progress in treating dissociative identity disorder.

3. A patient with panic disorder is prescribed alprazolam. Which instruction is most important for the nurse to include in the teaching plan?

• A. Avoid driving until you know how the medication affects you.
• B. Take the medication with food to avoid stomach upset.
• C. Take the medication at bedtime to help with sleep.
• D. Increase the dose if you do not feel better in a few days.

Correct answer: A

Rationale: The most important instruction for a patient prescribed alprazolam is to avoid driving until they know how the medication affects them. Alprazolam can cause drowsiness and impaired coordination, which may affect the ability to drive safely. This caution is crucial to prevent accidents and ensure the safety of the patient and others on the road.

4. When a patient is diagnosed with major depressive disorder, which nursing diagnosis should be the priority?

• A. Imbalanced nutrition: less than body requirements
• B. Risk for suicide
• C. Disturbed sleep pattern
• D. Ineffective coping

Correct answer: B

Rationale: The priority nursing diagnosis for a patient diagnosed with major depressive disorder is 'Risk for suicide.' This is the priority as it addresses the immediate risk of self-harm in individuals suffering from major depressive disorder. Monitoring and intervening to prevent self-harm take precedence over other nursing diagnoses in this scenario.

5. In cognitive processing therapy for PTSD, what is the primary goal for the patient?

• A. To help the patient process the trauma and reduce avoidance behaviors.
• B. To help the patient confront and process the trauma in a safe environment.
• C. To help the patient understand the impact of the trauma on their current thoughts and behaviors.
• D. To help the patient avoid triggers that remind them of the trauma.

Correct answer: C

Rationale: The primary goal of cognitive processing therapy for PTSD is to help the patient understand the impact of the trauma on their current thoughts and behaviors. Through this therapy, individuals learn to identify and challenge maladaptive beliefs related to the traumatic event, ultimately helping them to process the trauma and develop healthier coping mechanisms. This approach aims to address the cognitive distortions and negative thoughts that have resulted from the trauma, facilitating healing and recovery.

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