Nursing Elites

1. Which patient behavior is consistent with therapeutic communication?

• A. Offering your opinion when asked to provide support.
• B. Summarizing the essence of the patient’s comments in your own words.
• C. Avoiding interrupting periods of silence to allow the patient space to think.
• D. Providing positive reinforcement when the patient expresses themselves.

Correct answer: B

Rationale: Summarizing the essence of the patient’s comments in your own words is a key component of therapeutic communication. This behavior demonstrates active listening, ensures understanding of the patient's message, and encourages further discussion. By summarizing, you show the patient that you are engaged and interested, which helps them feel heard and valued. Offering your opinion (choice A) may bias the patient's thoughts and feelings, interrupting periods of silence (choice C) may prevent the patient from processing their thoughts, and providing positive reinforcement (choice D) may not always be appropriate or necessary in therapeutic communication.

2. Gilbert, age 19, is described by his parents as a ‘moody child’ with an onset of odd behavior at age 14, which caused Gilbert to suffer academically and socially. Gilbert has lost the ability to complete household chores, is reluctant to leave the house, and is obsessed with the locks on the windows and doors. Due to Gilbert’s early and slow onset of what is now recognized as schizophrenia, his prognosis is considered:

• A. Favorable with medication
• B. In the relapse stage
• C. Improvable with psychosocial interventions
• D. To have a less positive outcome

Correct answer: D

Rationale: A person like Gilbert, with an early and slow onset of schizophrenia along with severe symptoms such as loss of daily functioning and obsessions, is likely to have a less positive outcome. Early and severe symptoms are often associated with a more chronic and debilitating course of schizophrenia, which can make treatment and recovery more challenging. Therefore, Gilbert's prognosis is considered to have a less positive outcome. Choices A, B, and C are incorrect because Gilbert's condition, with its early onset and severe symptoms impacting daily life, suggests a more challenging prognosis that is less likely to be favorable with just medication or psychosocial interventions. Being in the relapse stage is not the primary concern here; the focus is on the overall outcome which is expected to be less positive given the early and severe nature of Gilbert's symptoms.

3. A patient with bipolar disorder is being educated by a nurse on the importance of medication adherence. Which statement by the patient indicates understanding?

• A. I will take my medication only when I feel manic symptoms.
• B. I understand that I need to take my medication regularly, even if I feel well.
• C. I will stop taking my medication if I experience side effects.
• D. I will take my medication whenever I remember.

Correct answer: B

Rationale: The correct answer is B. Taking medication regularly, even when feeling well, is crucial in managing bipolar disorder. Choice A is incorrect because medication adherence should not be based on symptoms alone. Choice C is incorrect as stopping medication due to side effects should be discussed with a healthcare provider. Choice D is incorrect because relying on memory may lead to missed doses, impacting treatment effectiveness.

4. A healthcare professional is caring for a group of clients. Which of the following clients should the healthcare professional consider for referral to an assertive community treatment (ACT) group?

• A. A client in an acute care mental health facility who has fallen several times while running down the hallway
• B. A client who lives at home and keeps forgetting to come in for a scheduled monthly antipsychotic injection for schizophrenia
• C. A client in a day treatment program who reports increasing anxiety during group therapy
• D. A client in a weekly grief support group who reports still missing a deceased partner who has been dead for 3 months

Correct answer: B

Rationale: The client who lives at home and repeatedly forgets to come in for a scheduled monthly antipsychotic injection for schizophrenia should be considered for referral to an assertive community treatment (ACT) group. ACT teams provide intensive community-based treatment and support for individuals with severe mental illness who may have difficulty adhering to treatment on their own. Choices A, C, and D do not describe individuals with severe mental illness who have difficulty adhering to treatment or need intensive community-based support, which are the typical candidates for referral to an ACT group.

5. During a mental health assessment, a patient states, 'I just don't see the point in anything anymore.' This statement is an indication of which of the following?

• A. Anxiety disorder
• B. Bipolar disorder
• C. Depression
• D. Schizophrenia

Correct answer: C

Rationale: The patient's statement 'I just don't see the point in anything anymore' reflects feelings of hopelessness and a lack of purpose, which are common symptoms of depression. Depression is characterized by persistent feelings of sadness, emptiness, and loss of interest or pleasure in activities that were once enjoyable. While anxiety disorders can involve excessive worry and fear, bipolar disorder includes episodes of both depression and mania, and schizophrenia typically involves symptoms such as hallucinations and delusions. Therefore, depression is the most appropriate choice based on the patient's statement.

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