Nursing Elites

1. An anxious client expressing a fear of people and open places is admitted to the psychiatric unit. What is the most effective way for the nurse to assist this client?

• A. Plan an outing within the second week of admission.
• B. Distract the client whenever they express discomfort about being with others.
• C. Confront the client's fears and discuss the possible causes of these fears.
• D. Accompany the client outside for an increasing amount of time each day.

Correct answer: D

Rationale: The most effective way to assist a client with a fear of people and open places is through gradual desensitization by controlled exposure to the situation which is feared (D). This method helps the client confront their fears in a safe and supportive manner, allowing them to gradually build confidence and reduce anxiety. Planning an outing within the second week of admission (A) may be too soon and overwhelming for the client. Distracting the client whenever they express discomfort (B) does not address the underlying issue and may promote denial. Confronting the client's fears and discussing possible causes (C) could be too aggressive initially and may not be well-tolerated by the client.

2. A male client is admitted to the psychiatric inpatient unit with a bandaged flesh wound after attempting to shoot himself. He was divorced one year ago, lost his job four months ago, and suffered a breakup of his current relationship last week. What is the most likely source of this client's current feelings of depression?

• A. Feelings of frustration.
• B. A sense of loss.
• C. Poor self-esteem.
• D. A lack of intimate relationships.

Correct answer: B

Rationale: The client's recent life events, including divorce, job loss, and relationship breakup, all contribute to a significant sense of loss, which is likely the source of his current feelings of depression. While feelings of frustration and poor self-esteem could be present, the major life events the client has experienced are more closely associated with a sense of loss. A lack of intimate relationships is not the primary factor contributing to his depression in this scenario.

3. A client with obsessive-compulsive disorder (OCD) repeatedly washes her hands throughout the day. What is the most therapeutic nursing intervention?

• A. Allow the client to continue the behavior to reduce anxiety.
• B. Encourage the client to talk about the underlying fears.
• C. Restrict the client's access to soap and water.
• D. Schedule a time for the client to perform the ritual.

Correct answer: B

Rationale: Encouraging the client to talk about the underlying fears is the most therapeutic nursing intervention for a client with OCD who repeatedly washes her hands. By discussing the fears, the client can gain insight into the behavior and work towards reducing the compulsion. Choice A is incorrect as allowing the client to continue the behavior can perpetuate the OCD symptoms. Choice C is incorrect as restricting access to soap and water can lead to increased anxiety and distress. Choice D is incorrect as scheduling a time for the client to perform the ritual does not address the underlying fears driving the behavior.

4. A female client with schizophrenia is experiencing auditory hallucinations. What is the most therapeutic response by the nurse?

• A. I don't hear any voices. They must be in your head.
• B. What are the voices telling you to do?
• C. You need to ignore the voices and focus on reality.
• D. I know the voices are real to you, but I don't hear them.

Correct answer: D

Rationale: Acknowledging the client's experience while gently presenting reality can help build trust and provide reassurance without reinforcing the hallucination.

5. A client with borderline personality disorder is admitted to the psychiatric unit after a suicide attempt. The client frequently expresses feelings of emptiness and fears of abandonment. What is the most therapeutic nursing approach for this client?

• A. Encourage the client to participate in all group activities.
• B. Set clear and consistent boundaries while providing empathy.
• C. Reassure the client that the staff will not abandon them.
• D. Explore the client's past relationships in depth.

Correct answer: B

Rationale: The most therapeutic nursing approach for a client with borderline personality disorder, who frequently expresses feelings of emptiness and fears of abandonment, is to set clear and consistent boundaries while providing empathy. This approach helps manage the client's fear of abandonment and feelings of emptiness, which are common in borderline personality disorder. Option A may overwhelm the client in a group setting without addressing their specific needs. Option C, while well-intentioned, may not fully address the underlying issues and may create dependency. Option D delves into the client's past relationships, which may be inappropriate and trigger emotional distress in a vulnerable client.

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