Nursing Elites

1. An unemployed college graduate is experiencing severe anxiety over not finding a teaching position and has difficulty with independent problem-solving. During a routine physical examination, the graduate confides in the clinic nurse. Which is the most appropriate nursing intervention?

• A. Encourage the graduate to use alternative coping mechanisms such as relaxation exercises.
• B. Complete the problem-solving process for the graduate.
• C. Work through the problem-solving process with the graduate.
• D. Encourage the graduate to keep a journal.

Correct answer: C

Rationale: In situations where a client is experiencing severe anxiety and struggles with independent problem-solving, it is essential for the nurse to work through the problem-solving process together with the client. By doing so, the nurse can provide support and guidance to help the client navigate through their challenges effectively. Choice A is not the most appropriate as just encouraging alternative coping mechanisms may not address the root of the problem. Choice B of completing the problem-solving process for the graduate does not promote independence or skill development. Choice D of encouraging the graduate to keep a journal may be helpful but does not directly address the need for assistance in problem-solving during heightened anxiety.

2. April, a 10-year-old admitted to inpatient pediatric care, has been getting more and more wound up and is losing self-control in the day room. Time-out does not appear to be an effective tool for April to engage in self-reflection. April's mother admits to putting her in time-out up to 20 times a day. The nurse recognizes that:

• A. Time-out is an important part of April's baseline discipline.
• B. Time-out is no longer an effective therapeutic measure.
• C. April enjoys time-out, and acts out to get some alone time.
• D. Time-out will need to be replaced with seclusion and restraint.

Correct answer: B

Rationale: Frequent use of time-out has reduced its effectiveness as a therapeutic measure for April.

3. During the assessment of an adolescent who collapsed during Olympic figure skating training and was diagnosed with severe malnutrition due to anorexia nervosa, which client statement supports the use of a family-based approach?

• A. I eat just as much as everyone else on the team
• B. I'm tired of fighting with my parents about eating
• C. I just didn't drink enough water during practice
• D. I have to practice until my skating routine is perfect

Correct answer: B

Rationale: The statement 'I'm tired of fighting with my parents about eating' indicates a struggle related to food and parental conflicts, suggesting family dynamics play a role in the client's eating disorder. In cases of anorexia nervosa in adolescents, involving the family in the treatment process through a family-based approach has shown to be effective. This approach recognizes the influence of family interactions on the development and maintenance of eating disorders, aiming to improve communication, support, and understanding within the family unit to facilitate recovery.

4. Why is the DSM-5 useful in the practice of psychiatric nursing?

• A. It guides the nurse in making accurate and reliable medical diagnoses.
• B. It represents progress toward a more holistic view of mind and body.
• C. It provides a framework for interdisciplinary communication.
• D. It provides a template for nursing care plans.

Correct answer: A

Rationale: The DSM-5 is a crucial tool in psychiatric nursing as it guides nurses in making accurate and reliable medical diagnoses of mental health conditions. Using the DSM-5 ensures that diagnoses are standardized, improving the quality and precision of care for clients. While the DSM-5 also supports a holistic view, interdisciplinary communication, and care plan development, its primary role in psychiatric nursing is to assist clinicians in diagnosing mental health conditions accurately.

5. At what point should the nurse determine that a client is at risk for developing a mental disorder?

• A. When thoughts, feelings, and behaviors are not reflective of the DSM-5 criteria
• B. When maladaptive responses to stress are coupled with interference in daily functioning
• C. When the client communicates significant distress
• D. When the client uses defense mechanisms as ego protection

Correct answer: B

Rationale: The nurse should determine that the client is at risk for mental disorder when responses to stress are maladaptive and interfere with daily functioning. The DSM-5 indicates that in order to be diagnosed with a mental disorder, there must be significant disturbance in cognition, emotion, regulation, or behavior that reflects a dysfunction in the psychological, biological or developmental processes underlying mental functioning. These disorders are usually associated with significant distress or disability in social, occupational, or other important activities. The client's ability to communicate distress would be considered a positive attribute.

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