Nursing Elites

1. Natasha's husband died suddenly two months ago, and she has been overwhelmed with grief. When Natasha is subsequently diagnosed with major depressive disorder, her daughter, Nadia, makes which true statement?

• A. Depression often begins after a major loss. Losing dad was a major loss.
• B. Bereavement and depression are the same problem.
• C. Mourning is pathological and not normal behavior.
• D. Antidepressant medications will not help this type of depression.

Correct answer: A

Rationale: When individuals experience a significant loss, such as the death of a loved one, it can trigger major depressive disorder. This is because the intense grief and sadness associated with the loss can lead to the development of depressive symptoms. Therefore, Nadia's statement that 'Depression often begins after a major loss' is accurate in this context.

2. A healthcare provider is providing care for a patient with major depressive disorder who is prescribed a tricyclic antidepressant (TCA). Which common side effect should the healthcare provider educate the patient about?

• A. Hypertension
• B. Diarrhea
• C. Dry mouth
• D. Weight loss

Correct answer: C

Rationale: Dry mouth is a common side effect associated with tricyclic antidepressants (TCAs). TCAs can cause anticholinergic side effects, such as dry mouth, due to their mechanism of action. Educating the patient about dry mouth can help them stay informed and manage this common side effect effectively during treatment. Hypertension (Choice A) is not a common side effect of TCAs. Diarrhea (Choice B) is more commonly associated with selective serotonin reuptake inhibitors (SSRIs) than with TCAs. Weight loss (Choice D) is not a common side effect of TCAs; in fact, TCAs are more likely to cause weight gain.

3. A client is diagnosed with generalized anxiety disorder (GAD). Which of the following interventions should the nurse implement? Select one that does not apply.

• A. Encourage the client to express their feelings
• B. Teach the client relaxation techniques
• C. Promote regular physical activity
• D. Encourage the use of caffeine

Correct answer: D

Rationale: Interventions for a client with GAD should include encouraging the client to express their feelings, teaching relaxation techniques, and promoting regular physical activity. Caffeine should be avoided as it can exacerbate anxiety symptoms. Stimulants like caffeine can increase feelings of restlessness and nervousness, making it counterproductive in managing anxiety. Choices A, B, and C are appropriate interventions for managing generalized anxiety disorder by promoting emotional expression, relaxation, and physical well-being, respectively. Choice D, encouraging the use of caffeine, is incorrect as it can worsen anxiety symptoms rather than alleviate them.

4. A new psychiatric nurse states, 'This client's use of defense mechanisms should be eliminated.' Which is a correct evaluation of this nurse's statement?

• A. Defense mechanisms can be self-protective responses to stress and need not be eliminated.
• B. Defense mechanisms are a maladaptive attempt by the ego to manage anxiety and should always be eliminated.
• C. Defense mechanisms, used by individuals with weak ego integrity, should be discouraged but not eliminated.
• D. Defense mechanisms cause disintegration of the ego and should be fostered and encouraged.

Correct answer: A

Rationale: The correct evaluation is that defense mechanisms can be self-protective responses to stress and do not necessarily need to be eliminated. These mechanisms help individuals reduce anxiety during times of stress. It is crucial for the nurse to understand that defense mechanisms serve a purpose and can be a normal part of coping. However, if defense mechanisms significantly hinder the client's ability to develop healthy coping skills, they should be addressed and explored. Eliminating defense mechanisms entirely without considering the individual's overall coping strategies can be counterproductive and may lead to increased distress for the client. Choice B is incorrect because not all defense mechanisms are maladaptive; some can be adaptive and helpful. Choice C is incorrect because labeling individuals as having weak ego integrity based on their use of defense mechanisms is stigmatizing and oversimplified. Choice D is incorrect because fostering and encouraging defense mechanisms without differentiation can lead to maladaptive behaviors and reliance on these mechanisms instead of healthier coping strategies.

5. 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.

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