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 has been prescribed escitalopram (Lexapro) for depression. Which instruction should the nurse include in the discharge teaching?

• A. Take the medication at bedtime to prevent daytime drowsiness.
• B. Avoid consuming alcohol while taking this medication.
• C. Take the medication with food to prevent stomach upset.
• D. Discontinue the medication if you start feeling better.

Correct answer: B

Rationale: The correct instruction for the nurse to include in the discharge teaching is to advise the client to avoid consuming alcohol while taking escitalopram (Lexapro). Alcohol can potentiate side effects such as drowsiness and dizziness when combined with this medication. Choice A is incorrect because escitalopram is usually taken in the morning due to its potential to cause insomnia if taken at bedtime. Choice C is incorrect because taking the medication with or without food does not significantly affect its absorption or side effects. Choice D is incorrect because it is essential for the client to continue taking the medication even if they start feeling better, as abruptly stopping an antidepressant can lead to withdrawal symptoms and a relapse of depression.

3. A school nurse is assessing a female high school student who is overly concerned about her appearance. The client's mother states, 'That's not something to be stressed about!' Which is the most appropriate nursing response?

• A. Teenagers! They don't know a thing about real stress.
• B. Stress occurs only when there is a loss.
• C. When you are in poor physical condition, you can't experience psychological well-being.
• D. Stress can be psychological. A threat to self-esteem may result in high stress levels.

Correct answer: D

Rationale: The most appropriate response is D: 'Stress can be psychological. A threat to self-esteem may result in high stress levels.' This response acknowledges the psychological aspect of stress and how a perceived threat to self-esteem can be just as stressful as a physiological change. Choices A, B, and C are incorrect because they do not address the client's concerns or provide a therapeutic response to the situation.

4. Which of the following interventions should not be implemented for a client with anorexia nervosa?

• A. Monitor daily caloric intake and weight
• B. Establish a structured eating plan
• C. Encourage the client to exercise
• D. Provide liquid supplements as prescribed

Correct answer: C

Rationale: Interventions for a client with anorexia nervosa should focus on monitoring daily caloric intake and weight, establishing a structured eating plan, providing liquid supplements as prescribed, and offering rewards for weight gain. Encouraging exercise is not recommended as it can worsen the condition by increasing energy expenditure and potentially reinforcing unhealthy behaviors associated with anorexia nervosa.

5. How does emotional trauma typically affect individuals physically?

• A. Emotional trauma is a distinct category and unrelated to physical symptoms.
• B. Physical manifestations of emotional trauma are usually temporary.
• C. Emotional trauma is often manifested as physical symptoms.
• D. Patients are more aware of physical problems caused by trauma.

Correct answer: C

Rationale: Emotional trauma can often manifest as physical symptoms, such as headaches, stomachaches, and other somatic complaints. These physical manifestations can be long-lasting and impact the individual's overall well-being.

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