Nursing Elites

1. 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.

2. A client is experiencing panic attacks. Which intervention should the nurse implement to help the client manage anxiety?

• A. Encourage the client to avoid situations that trigger anxiety.
• B. Encourage the client to practice deep breathing exercises.
• C. Encourage the client to take anti-anxiety medication as prescribed.
• D. Encourage the client to engage in regular physical activity.

Correct answer: B

Rationale: During panic attacks, deep breathing exercises can help the client manage anxiety effectively by promoting relaxation and reducing the intensity of symptoms. Encouraging the client to practice deep breathing can provide a quick and accessible strategy to cope with the immediate distress of a panic attack. Choices A, C, and D are incorrect because avoiding triggering situations may reinforce avoidance behavior, anti-anxiety medication is not the first-line intervention during a panic attack, and engaging in physical activity may not be feasible or effective during an acute episode of panic.

3. Which of the following is not a common symptom of major depressive disorder?

• A. Insomnia
• B. Feelings of hopelessness
• C. Increased energy
• D. Difficulty concentrating

Correct answer: C

Rationale: Common symptoms of major depressive disorder include insomnia, feelings of hopelessness, difficulty concentrating, and appetite changes. Increased energy is not typically associated with major depressive disorder; instead, fatigue is more commonly observed. This symptom differentiation helps in diagnosing major depressive disorder accurately.

4. When a husband accuses his wife of infidelity, which situation would indicate to the nurse the husband's use of the ego defense mechanism of projection?

• A. The husband cries and stamps his feet, demanding that his wife be true to her marriage vows.
• B. The husband ignores the wife's continued absence from the home.
• C. The husband has already admitted to having an affair with a coworker.
• D. The husband takes out his marital frustrations through employee abuse.

Correct answer: C

Rationale: Projection is a defense mechanism where one attributes their unacceptable feelings or impulses to another person. In this scenario, the husband, by admitting to having an affair with a coworker, is projecting his infidelity onto his wife, indicating the use of the projection defense mechanism. Choice A is incorrect as it describes a different behavior, not projection. Choice B does not demonstrate projection but rather avoidance or denial. Choice D shows displacement of aggression, not projection.

5. In assessing a patient for signs of serotonin syndrome, which of the following symptoms would be consistent with this condition?

• A. Hypotension, bradycardia, hypothermia
• B. Hypertension, tachycardia, hyperthermia
• C. Hypotension, tachycardia, hypothermia
• D. Hypertension, bradycardia, hyperthermia

Correct answer: B

Rationale: Serotonin syndrome is characterized by a triad of symptoms: hypertension, tachycardia, and hyperthermia. Therefore, the correct answer is B. Hypotension, bradycardia, and hypothermia (choice A) are not typical findings in serotonin syndrome. Hypotension, tachycardia, and hypothermia (choice C) are also not consistent with serotonin syndrome. Hypertension, bradycardia, and hyperthermia (choice D) do not align with the characteristic symptoms of serotonin syndrome. Recognizing the key symptoms of serotonin syndrome is crucial for prompt identification and intervention to prevent serious complications.

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