Nursing Elites

1. While reviewing the side effects of a newly prescribed medication, a 72-year-old client notes that one of the side effects is a reduction in sexual drive. Which is the best response by the nurse?

• A. How will this affect your present sexual activity?
• B. How active is your current sex life?
• C. How has your sex life changed as you have become older?
• D. Tell me about your sexual needs as an older adult.

Correct answer: A

Rationale: The best response in this scenario is option A, 'How will this affect your present sexual activity?' This response directly addresses the client's concern and allows them to express their thoughts and feelings. Option B does not directly address the client's worry about the medication's side effect. Options C and D deviate from the client's immediate concern and are not as relevant in this situation.

2. For which condition would electroconvulsive therapy (ECT) be used?

• A. Severe clinical depression
• B. Substance abuse disorders
• C. Antisocial personality disorder
• D. Psychosis occurring in schizophrenia

Correct answer: A

Rationale: Electroconvulsive therapy (ECT) is indicated for severe clinical depression, especially in cases where clients do not respond well to psychotropic medications or require immediate intervention due to the severity of their depression. ECT is not typically used as a primary treatment for substance abuse disorders, antisocial personality disorder, or psychosis occurring in schizophrenia. While ECT is an effective intervention for severe depression, it is important to consider individual client needs and response to other treatment options before resorting to ECT.

3. Which of the following is an advantage of working with psychiatric clients in a group setting?

• A. Clients assist each other through therapeutic interventions with the support of a nurse
• B. Clients can receive peer support and feedback in a safe and controlled environment
• C. Clients can share experiences and coping strategies while maintaining confidentiality
• D. Clients learn from others when their behaviors are inappropriate in a safe and trusting environment

Correct answer: D

Rationale: Group therapy is a valuable approach in mental health treatment. Working with psychiatric clients in a group setting offers various benefits. Clients in a group setting can learn from others when their behaviors are inappropriate in a safe and trusting environment. This environment allows individuals to express thoughts and feelings without fear of judgment or criticism, fostering a supportive atmosphere. Through interactions with peers, clients can gain insight into their own behaviors and learn alternative ways of coping. Choice A is incorrect as the presence and support of a nurse are typically important in group therapy sessions. Choice B is incorrect as group settings provide structure and rules to ensure a safe space for clients to express themselves. Choice C is incorrect as maintaining confidentiality is crucial in group therapy to build trust and encourage open sharing.

4. Which action often triggers an episode of violence or aggression in a patient with a psychiatric diagnosis involving violent behavior?

• A. Obtaining a history
• B. Asking for input into care
• C. Enforcing rules
• D. Taking a walk

Correct answer: C

Rationale: Enforcing rules is often a trigger for patients with psychiatric diagnoses involving violent behavior. Limit-setting or denying patient demands can be perceived as control and intimidation, leading to aggressive responses. Nursing staff must respond calmly and professionally to prevent escalation. Avoiding such patients or matching their emotions can worsen the situation. Therefore, enforcing rules can provoke violent episodes in these patients.

5. An older adult who recently began self-administration of insulin calls the nurse daily to review the steps that should be taken when giving an injection. The nurse has assessed the client's skills during two previous office visits and knows that the client is capable of giving the daily injection. Which response by the nurse is likely to be most helpful in encouraging the client to assume total responsibility for the daily injections?

• A. "I know you are capable of giving yourself the insulin."
• B. "Giving yourself the injection seems to make you nervous."
• C. "When I watched you give yourself the injection, you did it correctly."
• D. "Tell me what you want me to do to help you give yourself the injection at home."

Correct answer: C

Rationale: The most appropriate response by the nurse in this scenario is option C. By acknowledging and affirming the client's demonstrated ability to self-administer the injection correctly, the nurse is providing positive reinforcement. This positive reinforcement helps to build the client's confidence and encourages them to take total responsibility for their daily injections. Option A, while positive, does not specifically reinforce the client's behavior related to giving the injection. Option B focuses on the client's feelings of nervousness, which may not be helpful in promoting independence. Option D, by offering help without assessing the client's actual needs, reinforces dependence on the nurse rather than encouraging self-reliance.

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