Nursing Elites

1. Why might a nurse manager suggest avoiding therapeutic group work for a client with schizophrenia who has paranoid delusions?

• A. Individuals with this disorder respond well to small therapeutic groups.
• B. Therapeutic group work tends to be threatening to individuals who are suspicious.
• C. Compliance with unit rules and medication regimens increases as therapeutic group involvement increases.
• D. Involvement in small therapeutic groups may decrease the regression and dependency associated with institutionalization.

Correct answer: B

Rationale: The nurse manager would suggest avoiding therapeutic group work for a client with schizophrenia who has paranoid delusions because individuals who are suspicious find group settings threatening. Paranoid individuals struggle in groups as they may not trust others enough to engage effectively and tolerate the necessary interactions for group therapy. Therefore, the correct answer is that therapeutic group work tends to be threatening to individuals who are suspicious. Choices A, C, and D are incorrect. While some individuals with schizophrenia may respond well to small therapeutic groups, those with paranoid delusions may find them threatening. Compliance with unit rules and medication regimens may not necessarily increase with group therapy, especially for acutely ill psychiatric clients not ready to accept reality. Involvement in small therapeutic groups is not primarily aimed at decreasing regression and dependency associated with institutionalization, making it an inappropriate option for the client's specific needs.

2. Which response would the nurse make at lunchtime to a client who is sitting alone with the head slightly tilted as if listening to something?

• A. "I know you're busy, but it's lunchtime."
• B. "Are the voices bothering you again?"
• C. "Get going; you don't want to miss lunchtime."
• D. "It's lunchtime; I'll walk with you to the dining room."

Correct answer: D

Rationale: The statement, "It's lunchtime; I'll walk with you to the dining room," demonstrates setting limits and providing support. Hallucinations can be frightening, and the nurse's presence offers support and reality without focusing on the hallucination directly. Choice A, "I know you're busy, but it's lunchtime," does not recognize the client's need for support and direction. Choice B, "Are the voices bothering you again?", makes a judgment without sufficient evidence and overly focuses on the hallucination, failing to address the client's need for support and direction. Choice C, "Get going; you don't want to miss lunchtime," does not acknowledge the client's need for reality, support, and direction, and may come across as threatening.

3. Which type of environment would be most suitable for a confused client?

• A. Familiar
• B. Variable
• C. Challenging
• D. Stimulating

Correct answer: A

Rationale: The most appropriate environment for a confused client is a familiar one. A familiar environment provides security and safety, reducing stress for the confused client. Confused individuals struggle to adapt to constant changes, making a variable environment unsuitable. A challenging environment would likely increase anxiety and frustration in a confused client. Similarly, a stimulating environment could overwhelm the confused client, exacerbating their confusion.

4. After a mastectomy or a hysterectomy, a client may feel incomplete as a woman. Which statement would alert the nurse to this feeling in a client who has undergone a total hysterectomy?

• A. "I don't know who can help me during my recovery."
• B. "I feel washed out; there isn't much left."
• C. "I'm scared about the pain in recovery."
• D. "I can't wait to get home; I so want to see my grandchild."

Correct answer: B

Rationale: The correct answer is "I feel washed out; there isn't much left." This statement suggests a feeling of emptiness or incompleteness after the surgical procedure. Concern about who can assist during recovery, fear of pain, or excitement to go home and see a grandchild are not indicative of feeling incomplete as a woman after a hysterectomy. These other statements focus on practical concerns, physical discomfort, and positive emotions, respectively.

5. Which term describes what an adolescent client is experiencing when she says to the nurse who has been caring for her, 'You're just like my mother; I hate you'?

• A. Insight
• B. Universality
• C. Transference
• D. Identification

Correct answer: C

Rationale: Transference occurs when a client unconsciously assigns feelings and attitudes originally associated with another important person in the client's life. In this scenario, the adolescent client is projecting emotions connected to her mother onto the nurse. This client's statement does not demonstrate insight but rather reflects the mechanism of transference. Universality refers to the sense that one is not alone in any situation, which is not evident in the client's statement. Identification is a defense mechanism where an individual takes on characteristics of someone considered admirable, which is not the case in this situation.

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