Nursing Elites

1. What intervention should the nurse implement when caring for a patient demonstrating manic behavior?

• A. Monitor the patient’s vital signs frequently.
• B. Engage the patient in calming activities.
• C. Offer the patient a quiet environment for relaxation.
• D. Reduce environmental stimuli and create a calm atmosphere.

Correct answer: D

Rationale: When caring for a patient demonstrating manic behavior, the nurse should implement the intervention of reducing environmental stimuli and creating a calm atmosphere. This approach is crucial in managing manic behavior as it helps decrease triggers that may worsen the patient's symptoms. Engaging the patient in calming activities (Choice B) may not be effective during a manic episode as the patient may have difficulty focusing. While offering a quiet environment for relaxation (Choice C) is beneficial, it may not be sufficient to address the heightened stimulation experienced during mania. Monitoring the patient’s vital signs frequently (Choice A) is important in general patient care but may not directly address the specific needs of a patient exhibiting manic behavior.

2. In an acute mental health facility, a nurse is communicating with a client. The client states, “I can’t sleep. I stay up all night.” The nurse responds, “You are having difficulty sleeping?” Which of the following therapeutic communication techniques is the nurse demonstrating?

• A. Offering general leads
• B. Summarizing
• C. Focusing
• D. Restating

Correct answer: D

Rationale: The nurse is using the restating technique, where the nurse paraphrases or repeats the main idea expressed by the client to show understanding and encourage further communication. Restating helps clarify the client's message and fosters a therapeutic relationship. Choice A, offering general leads, involves encouraging the client to continue talking with nonverbal or minimal verbal prompts. Summarizing (Choice B) involves condensing and organizing the client's message. Focusing (Choice C) involves centering the conversation on a key element or topic.

3. Which of the following is an example of a cognitive-behavioral therapy (CBT) technique?

• A. Free association
• B. Thought stopping
• C. Dream analysis
• D. Systematic desensitization

Correct answer: B

Rationale: Thought stopping is a specific cognitive-behavioral therapy (CBT) technique aimed at helping individuals manage and interrupt negative or intrusive thoughts. This technique involves identifying and stopping negative thought patterns to promote healthier thinking and emotional well-being. Free association and dream analysis are associated with psychoanalytic therapy, while systematic desensitization is a technique commonly used in behavior therapy.

4. James is a 42-year-old patient with schizophrenia. He approaches you as you arrive for the day shift and anxiously reports, “Last night, demons came to my room and tried to rape me.” Which response would be most therapeutic?

• A. There are no such things as demons. What you saw were hallucinations.
• B. It is not possible for anyone to enter your room at night. You are safe here.
• C. You seem very upset. Please tell me more about what you experienced last night.
• D. That must have been very frightening, but we’ll check on you at night and you’ll be safe.

Correct answer: C

Rationale: The most therapeutic response acknowledges the patient's emotional state and invites further discussion about their experience. By saying, 'You seem very upset. Please tell me more about what you experienced last night,' the nurse shows empathy and openness, providing a supportive environment for the patient to express their feelings and perceptions.

5. A patient diagnosed with dissociative identity disorder has been undergoing therapy for several months. Which outcome indicates that the patient is progressing in therapy?

• A. The patient has developed a strong therapeutic relationship with the therapist.
• B. The patient’s different personalities are beginning to merge.
• C. The patient is able to recall traumatic events without dissociating.
• D. The patient reports fewer gaps in memory.

Correct answer: B

Rationale: In dissociative identity disorder, the merging of different personalities is a crucial indicator of progress in therapy. As the different identities merge, it signifies that the patient is integrating fragmented aspects of their self, leading to a more cohesive sense of identity and a reduction in dissociative symptoms. This process is a significant therapeutic milestone in the treatment of dissociative identity disorder as it promotes internal cohesion and decreases internal conflict. Choices A, C, and D are incorrect because while developing a strong therapeutic relationship, recalling traumatic events without dissociating, and reporting fewer gaps in memory are important aspects of therapy, the merging of different personalities is specifically indicative of substantial progress in treating dissociative identity disorder.

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