Nursing Elites

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

• A. Encouraging the patient to stop washing their hands
• B. Allowing the patient to wash hands at specified times
• C. Ignoring the patient's behavior
• D. Setting strict limits on the time allowed for hand washing

Correct answer: B

Rationale: In managing a patient with OCD who spends excessive time washing hands, allowing the patient to wash hands at specified times is the most appropriate nursing intervention. This approach helps establish a structured routine for hand washing, which can assist in managing OCD symptoms without reinforcing the behavior. Encouraging the patient to stop washing hands may lead to increased anxiety and resistance. Ignoring the behavior can perpetuate the cycle of OCD, and setting strict limits on hand washing time may cause distress and may not effectively address the underlying issues associated with OCD.

2. A client in an acute mental health facility is being discharged and requires supervision due to a severe mental illness. The client’s partner works all day but is home by late afternoon. Which of the following strategies should the nurse suggest for follow-up care?

• A. Receiving daily care from a home health aide
• B. Having a weekly visit from a nurse case worker
• C. Attending a partial hospitalization program
• D. Visiting a community mental health center on a daily basis

Correct answer: C

Rationale: For clients requiring supervision due to severe mental illness, attending a partial hospitalization program provides structured care and support while allowing the client to return home in the evenings, making it a suitable option for follow-up care. The other choices are less appropriate: A home health aide may not provide the necessary level of care and supervision, a weekly visit from a nurse case worker may not be sufficient for the client's needs, and visiting a community mental health center on a daily basis may not offer the structured support required for someone with a severe mental illness.

3. 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.

4. Which therapeutic approach is most effective for a patient with generalized anxiety disorder (GAD)?

• A. Psychoanalytic therapy
• B. Cognitive-behavioral therapy (CBT)
• C. Humanistic therapy
• D. Gestalt therapy

Correct answer: B

Rationale: Cognitive-behavioral therapy (CBT) is the most effective therapeutic approach for generalized anxiety disorder (GAD). CBT helps individuals identify and modify negative thought patterns and behaviors that contribute to anxiety. It focuses on changing cognitive distortions and maladaptive behaviors, providing practical strategies to manage anxiety symptoms effectively. Numerous studies have shown the effectiveness of CBT in treating GAD by helping patients develop coping mechanisms and skills to address their anxiety. Choice A, Psychoanalytic therapy, is not the most effective for GAD as it primarily focuses on exploring unconscious conflicts and childhood experiences rather than providing immediate coping strategies. Choice C, Humanistic therapy, emphasizes personal growth and self-improvement, which may not directly target the specific symptoms of GAD. Choice D, Gestalt therapy, focuses on increasing self-awareness and personal responsibility, which might not address the cognitive distortions and behavioral patterns associated with GAD as directly as CBT does.

5. A patient with posttraumatic stress disorder (PTSD) is experiencing nightmares. Which intervention should the nurse include in the care plan?

• A. Encouraging the patient to journal before bedtime
• B. Teaching relaxation techniques
• C. Avoiding discussing the nightmares directly
• D. Developing a safety plan

Correct answer: B

Rationale: Teaching relaxation techniques is an appropriate intervention for a patient with PTSD experiencing nightmares. Relaxation techniques can help the patient manage anxiety and improve sleep quality, potentially decreasing the frequency and intensity of nightmares. By teaching relaxation techniques, the nurse empowers the patient to actively cope with and reduce the distressing symptoms of PTSD, contributing to overall therapeutic outcomes.

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