Nursing Elites

1. Which characteristic is most commonly associated with dissociative identity disorder?

• A. Frequent nightmares
• B. Auditory hallucinations
• C. Multiple distinct personalities
• D. Chronic fatigue

Correct answer: C

Rationale: Dissociative identity disorder, commonly known as multiple personality disorder, is characterized by the presence of two or more distinct personality states within an individual. These distinct personalities may have their own way of perceiving and interacting with the world, often leading to gaps in memory and a sense of detachment. Frequent nightmares, auditory hallucinations, and chronic fatigue are not primary characteristics of dissociative identity disorder. Option C, multiple distinct personalities, is the hallmark feature of this disorder, making it the correct choice.

2. What is the priority nursing intervention for a patient experiencing a panic attack?

• A. Encourage the patient to talk about their feelings.
• B. Provide a safe, calm environment.
• C. Administer prescribed anti-anxiety medication.
• D. Teach the patient deep breathing exercises.

Correct answer: B

Rationale: The priority nursing intervention for a patient experiencing a panic attack is to provide a safe, calm environment. This action is crucial as it helps reduce the patient's anxiety and creates a sense of security, which can aid in managing the panic attack effectively. Encouraging the patient to talk about their feelings, administering medication, or teaching deep breathing exercises can be beneficial interventions, but creating a safe and calm environment takes precedence in addressing the immediate needs of the patient during a panic attack.

3. A 33-year-old female diagnosed with bipolar I disorder has been functioning well on lithium for 11 months. At her most recent checkup, the psychiatric nurse practitioner states, ‘You are ready to enter the maintenance therapy stage, so at this time I am going to adjust your dosage by prescribing:'

• A. A higher dosage
• B. Once-a-week dosing
• C. A lower dosage
• D. A different drug

Correct answer: C

Rationale: As the patient transitions to maintenance therapy, the typical approach involves decreasing the dosage to a lower level. This adjustment is made to find the minimum effective dose needed for symptom control while reducing the potential side effects associated with long-term use. Choosing a higher dosage (A) would not align with the goal of maintenance therapy, as it may increase the risk of adverse effects. Once-a-week dosing (B) is not a common adjustment for lithium, which is usually prescribed daily for bipolar disorder. Switching to a different drug (D) is typically considered if the current medication is ineffective or intolerable, not as a routine step in transitioning to maintenance therapy.

4. Carolina is surprised when her patient does not show for a regularly scheduled appointment. When contacted, the patient states, “I don’t need to come see you anymore. I have found a therapy app on my phone that I love.” How should Carolina respond to this news?

• A. That sounds exciting; would you be willing to visit and show me the app?
• B. At this time, there is no real evidence that the app can replace our therapy.
• C. I am not sure that is a good idea right now; we are so close to progress.
• D. Why would you think that is a better option than meeting with me?

Correct answer: A

Rationale: Carolina should respond by showing interest in the app, as it can help maintain the therapeutic relationship and provide an opportunity to evaluate the app's effectiveness together. By asking the patient to visit and show the app, Carolina demonstrates openness to exploring new tools that the patient finds helpful, while also ensuring that the patient's well-being remains a priority. This approach fosters communication, allows for a collaborative discussion on how the app fits into the patient's treatment plan, and may potentially address any concerns or misconceptions the patient has about the app replacing traditional therapy.

5. What principle about patient communication should guide a nurse's fear of 'saying the wrong thing' to a patient?

• A. Patients tend to appreciate a well-meaning person who conveys genuine acceptance, respect, and concern for their situation.
• B. Patients are more interested in talking to you than listening to what you have to say, so they are not likely to be offended.
• C. Considering the patient's history, there is little chance that the comment will do any actual harm.
• D. Most people with a mental illness have, by necessity, developed a high tolerance for forgiveness.

Correct answer: A

Rationale: Effective patient communication is guided by the principle that patients value genuine acceptance, respect, and concern from their caregivers. This approach helps to build trust and fosters effective communication, enhancing the nurse-patient relationship. Choice B is incorrect because patients value both talking and listening in effective communication. Choice C is incorrect because a nurse should always consider the impact of their words on the patient, regardless of the patient's history. Choice D is incorrect as it generalizes about people with mental illness and forgiveness, which is not directly relevant to patient communication.

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