Nursing Elites

1. You have been working closely with a patient for the past month. Today he tells you he is looking forward to meeting with his new psychiatrist but frowns and avoids eye contact while reporting this to you. Which of the following responses would most likely be therapeutic?

• A. A new psychiatrist is a chance to start fresh; I'm sure it will go well for you.
• B. You say you look forward to the meeting, but you appear anxious or unhappy.
• C. I notice that you frowned and avoided eye contact just now. Don't you feel well?
• D. I get the impression you don't really want to see your psychiatrist—can you tell me why?

Correct answer: B

Rationale: Choice B is the most therapeutic response as it acknowledges the discrepancy between the patient's verbal statement and nonverbal cues. By addressing both the patient's expressed anticipation and the conflicting nonverbal cues of frowning and avoiding eye contact, the responder demonstrates attentiveness to the patient's emotional state and encourages further exploration of underlying feelings. This approach fosters open communication and helps the patient feel understood and supported.

2. Which of the following interventions are appropriate for a client experiencing a panic attack? Select one that does not apply.

• A. Stay with the client and remain calm
• B. Encourage deep breathing
• C. Move the client to a quiet environment
• D. Mindfulness meditation

Correct answer: D

Rationale: During a panic attack, it is crucial to provide immediate support to the client. Appropriate interventions include staying with the client and remaining calm, encouraging deep breathing, and moving the client to a quiet environment. However, mindfulness meditation, which involves focusing on the present moment and may require a certain level of concentration, may not be feasible or effective during an acute panic attack. The priority is to help the client feel safe and supported, which the other interventions address more directly. Mindfulness meditation might not be suitable during a panic attack due to the heightened state of anxiety and the need for immediate calming techniques.

3. Which of the following is an uncommon symptom of schizophrenia?

• A. Delusions
• B. Fatigue
• C. Disorganized speech
• D. Catatonia

Correct answer: B

Rationale: Common symptoms of schizophrenia include delusions, hallucinations, disorganized speech, and catatonia. Fatigue is not typically considered a direct symptom of schizophrenia. It is important to focus on symptoms directly related to the disorder when identifying schizophrenia.

4. Child protective services have removed 10-year-old Christopher from his parents' home due to neglect. Christopher reveals to the nurse that he considers the woman next door his 'nice' mom, that he loves school, and gets above-average grades. The strongest explanation of this response is:

• A. Temperament
• B. Genetic factors
• C. Resilience
• D. Paradoxical effects of neglect

Correct answer: C

Rationale: Christopher's positive outlook, strong school performance, and forming a bond with the neighbor indicate resilience. Resilience refers to the ability to adapt and thrive despite facing adversity, such as being removed from his parents' home due to neglect. His ability to maintain a positive attitude and excel in school despite the challenging circumstances highlights his resilience.

5. A healthcare professional is assessing a client diagnosed with narcissistic personality disorder. Which of the following behaviors should the healthcare professional expect?

• A. Grandiose sense of self-importance
• B. Lack of empathy
• C. Need for excessive admiration
• D. Envy of others

Correct answer: A

Rationale: Clients with narcissistic personality disorder often exhibit a grandiose sense of self-importance, believing they are special and unique. This behavior is characterized by an exaggerated sense of achievements and talents, expecting to be recognized as superior without commensurate achievements. While individuals with this disorder may lack empathy and have a need for excessive admiration, the prominent feature of grandiosity is a core aspect of narcissistic personality disorder. Therefore, the correct behavior expected in this case is a grandiose sense of self-importance (Choice A). Lack of empathy (Choice B) and need for excessive admiration (Choice C) are also common traits in narcissistic personality disorder, but they are not the primary behavior associated with the disorder. Envy of others (Choice D) is not a characteristic behavior typically seen in individuals with narcissistic personality disorder.

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