Nursing Elites

1. An adolescent with anorexia nervosa is participating in a cognitive-behavioral therapy (CBT) program. Which behavior indicates that the therapy is effective?

• A. Client adheres to a meal plan and gains weight.
• B. Client discusses the impact of the disorder on family.
• C. Client expresses a desire to change behavior.
• D. Client reduces the frequency of binge eating.

Correct answer: A

Rationale: In treating anorexia nervosa with cognitive-behavioral therapy (CBT), the primary goals are to normalize eating behaviors and achieve weight restoration. Therefore, adherence to a meal plan and weight gain are crucial indicators of treatment effectiveness. While discussing the impact of the disorder on the family (Choice B) can be beneficial for therapy, it may not directly indicate the effectiveness of CBT in treating anorexia nervosa. Expressing a desire to change behavior (Choice C) is a positive step, but actual behavioral changes such as adhering to a meal plan are more indicative of progress. Reducing the frequency of binge eating (Choice D) is more relevant for other eating disorders like bulimia nervosa, not anorexia nervosa.

2. While sitting in the day room of the mental health unit, a male adolescent avoids eye contact, looks at the floor, and talks softly when interacting verbally with the RN. The two trade places, and the RN demonstrates the client's behaviors. What is the main goal of this therapeutic technique?

• A. Initiate a non-threatening conversation with the client.
• B. Dialog about the ineffectiveness of his interactions.
• C. Allow the client to identify the way he interacts.
• D. Discuss the client's feelings when he responds.

Correct answer: C

Rationale: The main goal of the therapeutic technique described is to allow the client to identify the way he interacts. This technique helps promote self-awareness in the client by mirroring his behavior back to him, which can lead to insights about his own communication style. Option A is incorrect as the goal is not just to initiate conversation but to facilitate self-reflection. Option B is incorrect because the focus is not on discussing the ineffectiveness of the interactions but on self-awareness. Option D is incorrect as the primary aim is not to discuss the client's feelings but to help him recognize his interaction patterns.

3. A male client with bipolar disorder who began taking lithium carbonate five days ago is complaining of excessive thirst, and the nurse finds him attempting to drink water from the bathroom sink faucet. Which intervention should the nurse implement?

• A. Report the client’s serum lithium level to the healthcare provider.
• B. Encourage the client to suck on hard candy to relieve the symptoms.
• C. No action is needed since polydipsia is a common side effect.
• D. Tell the client that drinking from the faucet is not allowed.

Correct answer: B

Rationale: Encouraging the client to suck on hard candy is the appropriate intervention as it can help alleviate the sensation of excessive thirst, which is a common side effect of lithium. Reporting the client’s serum lithium level to the healthcare provider may be needed if there are signs of lithium toxicity, but the priority here is to address the immediate symptom of excessive thirst. Polydipsia, or excessive thirst, is a known side effect of lithium, but it should not be left unaddressed. Simply telling the client that drinking from the faucet is not allowed does not address the underlying issue of excessive thirst and may lead to further distress.

4. A male hospital employee is pushed out of the way by a female employee because of an oncoming gurney. The pushed employee becomes very angry and swings at the female employee. Both employees are referred for counseling with the staff psychiatric nurse. Which factor in the pushed employee’s history is most related to the reaction that occurred?

• A. Is worried about losing his job to a woman.
• B. Tortured animals as a child.
• C. Was physically abused by his mother.
• D. Hates to be touched by anyone.

Correct answer: C

Rationale: The correct answer is 'C: Was physically abused by his mother.' The pushed employee's aggressive reaction can be attributed to his history of physical abuse. Research suggests that individuals who have experienced physical abuse may exhibit heightened aggressive responses due to trauma and learned behavior. Choices A, B, and D are incorrect: A is a stereotype-based assumption that does not have a direct correlation with the aggressive behavior observed; B, torturing animals, is concerning behavior but not directly linked to the aggressive response in this scenario; D, hating to be touched, is not the most relevant factor considering the situation described.

5. A client with major depressive disorder is beginning a new antidepressant medication. Which instruction should the nurse include in the discharge teaching?

• A. “It may take several weeks to notice improvement.”
• B. “You should see immediate effects of the medication.”
• C. “You can stop taking the medication once you feel better.”
• D. “Avoid discussing your symptoms with your therapist.”

Correct answer: A

Rationale: The correct instruction the nurse should include in the discharge teaching for a client starting a new antidepressant medication is that “It may take several weeks to notice improvement.” This is because antidepressants often require several weeks before the individual starts to feel the full therapeutic effects. Choice B is incorrect because immediate effects are not typically seen with antidepressants. Choice C is incorrect as stopping the medication abruptly can lead to worsening symptoms or withdrawal effects. Choice D is incorrect as open communication with the therapist is crucial for effective management of major depressive disorder.

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