Nursing Elites

1. When assessing a patient with generalized anxiety disorder (GAD), which symptom would the nurse most likely observe?

• A. Flashbacks
• B. Excessive worry
• C. Hallucinations
• D. Compulsive behaviors

Correct answer: B

Rationale: Excessive worry is a characteristic feature of generalized anxiety disorder (GAD). Patients with GAD experience persistent and excessive worry about various aspects of their life, such as work, health, or family, even when there is little or no reason for concern. This chronic worrying can significantly impact their daily functioning and quality of life. Flashbacks are more commonly associated with post-traumatic stress disorder (PTSD), hallucinations are more typical in conditions like schizophrenia, while compulsive behaviors are seen in obsessive-compulsive disorder (OCD). Therefore, in the context of GAD, excessive worry is the symptom that the nurse is most likely to observe.

2. When interviewing a distressed client who was fired after 15 years of loyal employment, which of the following questions would best assist the nurse in determining the client's appraisal of the situation? Select the one that does not apply.

• A. What coping resources have you used previously in stressful situations?
• B. Have you ever faced a similar stressful situation before?
• C. Who do you think is to blame for this situation?
• D. What do you believe led to your termination from your job?

Correct answer: C

Rationale: In this scenario, it is crucial for the nurse to help the client assess their coping mechanisms and perspective on the situation. Questions A and B focus on exploring the client's coping resources and past experiences to guide them towards effective stress management. Asking who is to blame (choice C) is not conducive to evaluating coping abilities; instead, it might elicit a blame-focused response, which can impede progress. Choice D, inquiring about the reason for being fired, is a nontherapeutic approach that does not promote a constructive appraisal of the situation.

3. During a treatment team meeting, the point is made that a client with schizophrenia has recovered from the acute psychosis but continues to demonstrate apathy, avolition, and blunted affect. The nurse who relates these symptoms to serotonin excess will suggest that the client receive?

• A. Chlorpromazine
• B. Phenelzine
• C. Haloperidol
• D. Olanzapine

Correct answer: D

Rationale: In this scenario, the symptoms of apathy, avolition, and blunted affect are indicative of negative symptoms commonly seen in schizophrenia. These symptoms are often associated with dopamine and serotonin imbalances in the brain. Olanzapine, an atypical antipsychotic, is known for its efficacy in treating both positive and negative symptoms of schizophrenia. It acts by blocking serotonin and dopamine receptors, helping to alleviate the symptoms mentioned. Chlorpromazine and Haloperidol are typical antipsychotics that primarily target dopamine receptors, while Phenelzine is an MAOI used to treat depression and anxiety disorders, not schizophrenia. Therefore, the most appropriate choice for this client displaying these symptoms related to serotonin excess would be Olanzapine.

4. Which client action is an example of the defense mechanism of displacement?

• A. A man kicks his dog after an argument with his boss.
• B. A woman yells at her children after a stressful day at work.
• C. A student immerses herself in studying to avoid thinking about a recent breakup.
• D. A person channels aggressive impulses into playing a sport.

Correct answer: B

Rationale: Displacement involves redirecting emotions, often anger or aggression, from their original source to a less threatening target. In this scenario, the woman redirects her frustration from work towards her children, who are perceived as less threatening and safer to express anger towards.

5. A healthcare provider is assessing a client with suspected bipolar disorder. Which of the following findings should the healthcare provider expect? Select one that does not apply.

• A. Periods of elevated mood
• B. Decreased need for sleep
• C. Flight of ideas
• D. Anhedonia

Correct answer: D

Rationale: Findings in a client with bipolar disorder typically include periods of elevated mood, decreased need for sleep, and flight of ideas. Anhedonia, characterized by the inability to experience pleasure, is more commonly associated with major depressive disorder. Therefore, the healthcare provider should not expect anhedonia in a client with suspected bipolar disorder. The other choices are characteristic features of bipolar disorder, such as mania or hypomania.

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