Nursing Elites

1. Which of the following interventions should not be included in the care plan for a client with major depressive disorder?

• A. Encourage participation in activities
• B. Promote adequate nutrition and hydration
• C. Discourage verbalization of feelings
• D. Monitor for suicidal ideation

Correct answer: C

Rationale: Interventions for a client with major depressive disorder should focus on promoting activities, adequate nutrition, hydration, and monitoring for suicidal ideation. Verbalizing feelings is a crucial part of therapy for clients with depression as it helps in processing emotions and seeking support. Therefore, discouraging verbalization of feelings is not appropriate and goes against therapeutic principles.

2. 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: Response C is the most therapeutic as it shows empathy and encourages the patient to express their feelings and share more about their experience. By actively listening and inviting the patient to talk, the nurse creates a supportive environment that can help the patient feel heard and understood, which is essential in building trust and rapport in therapeutic communication with individuals experiencing schizophrenia.

3. In a client with obsessive-compulsive disorder (OCD) undergoing cognitive-behavioral therapy, which outcome indicates that the therapy is effective?

• A. The client reports a decrease in the frequency of compulsive behaviors.
• B. The client reports a decrease in the intensity of obsessive thoughts.
• C. The client reports an improvement in overall mood.
• D. The client reports an improvement in sleep patterns.

Correct answer: A

Rationale: In clients with OCD undergoing cognitive-behavioral therapy, a decrease in the frequency of compulsive behaviors is a key indicator of treatment effectiveness. This reduction signifies progress in managing and controlling the compulsions associated with OCD, which is a primary goal of the therapy. Choices B, C, and D may also be positive outcomes of therapy, but the most critical aspect in treating OCD with cognitive-behavioral therapy is targeting and reducing the frequency of compulsive behaviors.

4. The school nurse has been alerted to the fact that an 8-year-old boy routinely playacts as a police officer, 'locking up' other children on the playground to the point where the children get scared. The nurse recognizes that this behavior is most likely an indication of:

• A. The need to dominate others
• B. Inventing traumatic events
• C. A need to develop close relationships
• D. A potential symptom of traumatization

Correct answer: D

Rationale: The behavior of an 8-year-old boy playacting as a police officer and 'locking up' other children to the point of scaring them is likely a symptom of traumatization. Children may reenact traumatic experiences through play, and acting out aggressive or controlling roles can be a sign of underlying trauma. This behavior should be further assessed and addressed with appropriate support and intervention to help the child process and cope with any potential trauma.

5. When evaluating a client's progress in psychotherapy, which outcome is appropriate for the client?

• A. The client will identify triggers for anxiety.
• B. The client will develop coping strategies.
• C. The client will decrease avoidance behaviors.
• D. The client will express feelings of anger.

Correct answer: A

Rationale: In psychotherapy, identifying triggers for anxiety is a crucial step towards understanding and managing one's anxiety symptoms. By recognizing these triggers, clients can work on developing coping strategies and addressing the root cause of their anxiety, leading to improved mental health outcomes. Decreasing avoidance behaviors and expressing feelings of anger are also important aspects of therapy. However, identifying triggers for anxiety is a more specific and foundational goal in addressing anxiety disorders, making it the most appropriate outcome to evaluate a client's progress in psychotherapy.

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