Nursing Elites

1. Therapeutic communication is the foundation of a patient-centered interview. Which of the following techniques is not considered therapeutic?

• A. Restating
• B. Encouraging description of perception
• C. Summarizing
• D. Asking 'why' questions

Correct answer: D

Rationale: Asking 'why' questions is not considered a therapeutic technique in patient-centered communication as it can make patients feel defensive or judged. 'Why' questions may imply criticism or put the patient on the spot, potentially hindering open and honest communication. Instead, focusing on open-ended questions that encourage patients to express their feelings and thoughts without feeling judged or interrogated is more conducive to therapeutic communication.

2. A client has been diagnosed with post-traumatic stress disorder (PTSD) and is having nightmares about the event. The client reports difficulty sleeping at night. Which of the following actions should the nurse take first?

• A. Encourage the client to talk about the event during the day.
• B. Encourage the client to avoid caffeine and alcohol.
• C. Administer a prescribed sedative at bedtime.
• D. Schedule a follow-up appointment with the client's therapist.

Correct answer: A

Rationale: The initial action the nurse should take is to encourage the client to talk about the traumatic event during the day. This approach can assist the client in processing the trauma in a controlled environment, potentially reducing the frequency and intensity of nightmares. It allows for emotional expression and may promote better sleep by addressing the underlying psychological distress associated with PTSD. Encouraging the client to talk about the event during the day promotes therapeutic processing of the trauma and emotional expression, which can lead to improved coping mechanisms and potentially decrease the distressing symptoms like nightmares. Encouraging the client to avoid caffeine and alcohol may be beneficial, but addressing the emotional aspects first is crucial. Administering a sedative should not be the first approach, as it does not address the root cause of the nightmares. Scheduling a follow-up appointment with the therapist is important but should follow addressing the immediate distressing symptoms and promoting coping strategies.

3. A client is prescribed lorazepam (Ativan) for the management of anxiety. Which statement by the client indicates the need for further teaching?

• A. I should take this medication at the same time every day.
• B. I can drink alcohol while taking this medication.
• C. I should avoid driving while taking this medication.
• D. I should avoid using this medication during pregnancy.

Correct answer: B

Rationale: The correct answer is B. Clients should avoid alcohol while taking lorazepam (Ativan) due to potential interactions. Alcohol can increase the side effects of lorazepam, such as drowsiness and dizziness, which can be dangerous, especially when combined with activities like driving or operating machinery. Choice A is correct as it promotes medication adherence. Choice C is correct as lorazepam can impair cognitive and motor skills, impacting driving ability. Choice D is correct as lorazepam is not recommended during pregnancy due to potential harm to the fetus.

4. For a patient diagnosed with borderline personality disorder exhibiting self-harming behavior, which therapeutic approach is most appropriate?

• A. Dialectical behavior therapy
• B. Psychoanalysis
• C. Supportive therapy
• D. Pharmacotherapy

Correct answer: A

Rationale: The most appropriate therapeutic approach for a patient diagnosed with borderline personality disorder exhibiting self-harming behavior is dialectical behavior therapy (DBT). DBT is specifically designed to address the core symptoms of borderline personality disorder, including self-harming behaviors. It focuses on teaching patients skills to manage emotions, improve interpersonal relationships, and enhance distress tolerance. Psychoanalysis (Choice B) is not the most appropriate for immediate symptom management in this case. Supportive therapy (Choice C) may not provide the structured approach needed to address self-harming behaviors effectively. Pharmacotherapy (Choice D) may be used as an adjunct in some cases, but DBT is the frontline therapy for managing self-harming behaviors in borderline personality disorder.

5. A healthcare professional is assessing a client who is experiencing severe anxiety. Which of the following is an appropriate intervention?

• A. Encourage the client to talk about their feelings.
• B. Provide a quiet and calm environment.
• C. Encourage the client to exercise vigorously.
• D. Encourage the client to participate in group activities.

Correct answer: B

Rationale: During severe anxiety, it is essential to create a quiet and calm environment to help the client feel safe and reduce anxiety levels. Loud or stimulating environments can exacerbate anxiety symptoms, so providing a serene setting can promote relaxation and a sense of security.

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