Nursing Elites

1. Which statement by the patient indicates a need for further teaching regarding the treatment of major depressive disorder?

• A. I have been on this antidepressant for 3 days. I understand that the full effect may take weeks to occur.
• B. I am going to ask my nurse practitioner to discontinue my Prozac today and let me start taking a monoamine oxidase inhibitor tomorrow.
• C. I may ask to have my medication changed to Wellbutrin due to the problems I am having being romantic with my wife.
• D. I realize that there are many antidepressants and it might take a while until we find the one that works best for me.

Correct answer: B

Rationale: Choice B indicates a need for further teaching because the patient is planning to switch directly from Prozac, an SSRI, to a monoamine oxidase inhibitor (MAOI) without allowing for a washout period. This abrupt switch poses a risk of serotonin syndrome, which can be life-threatening. It is essential to educate the patient about the importance of consulting healthcare providers before changing medications to prevent potential adverse effects.

2. A client diagnosed with major depressive disorder is receiving cognitive-behavioral therapy (CBT). Which outcome indicates that the therapy is effective?

• A. The client identifies and challenges negative thoughts.
• B. The client reports an increase in suicidal thoughts.
• C. The client experiences an increase in anxiety.
• D. The client shows no change in behavior.

Correct answer: A

Rationale: In cognitive-behavioral therapy (CBT), one of the primary objectives is to help clients identify and challenge their negative thoughts. This process allows the individual to reframe their thinking patterns and develop more adaptive coping strategies. Reporting an increase in suicidal thoughts (Choice B) or experiencing an increase in anxiety (Choice C) are not desired outcomes and may indicate a need for further intervention. Showing no change in behavior (Choice D) suggests that the therapy has not been effective. Therefore, the correct indicator of effective therapy in this context is the client's ability to identify and challenge negative thoughts (Choice A).

3. When assessing a patient with generalized anxiety disorder (GAD), which symptom would a nurse most likely observe?

• A. Flashbacks
• B. Excessive worry
• C. Hallucinations
• D. Compulsive behaviors

Correct answer: B

Rationale: Excessive worry is a primary characteristic of generalized anxiety disorder (GAD). Patients with GAD experience persistent and excessive worry about various aspects of their lives, often anticipating disaster or catastrophic outcomes. This worry is difficult to control and can be accompanied by physical symptoms like restlessness, fatigue, irritability, muscle tension, and difficulty concentrating. Flashbacks are more commonly associated with post-traumatic stress disorder (PTSD), hallucinations are more typical of psychotic disorders, and compulsive behaviors are characteristic of obsessive-compulsive disorder (OCD). Therefore, when assessing a patient with GAD, a nurse would most likely observe excessive worry.

4. A client with bipolar disorder is experiencing a manic episode. Which of the following interventions should the nurse avoid implementing?

• A. Provide a structured environment
• B. Encourage rest periods
• C. Limit setting on inappropriate behaviors
• D. Allow the client to engage in stimulating activities

Correct answer: D

Rationale: During a manic episode in bipolar disorder, interventions should focus on providing a structured environment, encouraging rest periods, and setting limits on inappropriate behaviors. Allowing the client to engage in stimulating activities may exacerbate the symptoms of mania, such as increased energy, impulsivity, and risk-taking behaviors. Therefore, it is important to avoid encouraging such activities to prevent worsening of manic symptoms.

5. Cognitive-behavioral therapy (CBT) is often used to treat which of the following conditions?

• A. Schizophrenia
• B. Bipolar disorder
• C. Posttraumatic stress disorder
• D. Generalized anxiety disorder

Correct answer: D

Rationale: Cognitive-behavioral therapy (CBT) is a widely used therapeutic approach effective in treating various mental health conditions. While CBT can be beneficial for different disorders, it is particularly well-suited for anxiety-related conditions like generalized anxiety disorder. CBT focuses on identifying and modifying negative thought patterns and behaviors contributing to anxiety, making it a suitable choice for treating generalized anxiety disorder. Therefore, the correct answer is D. Choices A, B, and C are incorrect because CBT is not typically the first-line treatment for schizophrenia, bipolar disorder, or posttraumatic stress disorder, although it may be used as a part of a comprehensive treatment plan.

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