Nursing Elites

1. A client has a history of excessive drinking, which has led to multiple arrests for driving under the influence (DUI). The client states, 'I work hard to provide for my family. I don't see why I can't drink to relax.' The nurse recognizes the use of which defense mechanism?

• A. Projection
• B. Rationalization
• C. Regression
• D. Sublimation

Correct answer: B

Rationale: The nurse should recognize that the client is using rationalization, a common defense mechanism. Rationalization involves creating logical reasons to justify unacceptable feelings or behaviors. In this scenario, the client is justifying excessive drinking by linking it to hard work and the need for relaxation, masking the true underlying issue of alcohol abuse. Projection involves attributing one's thoughts or feelings to others, regression involves reverting to an earlier stage of development, and sublimation involves channeling unacceptable impulses into socially acceptable activities, none of which are demonstrated in the client's statement.

2. Which of the following are potential side effects of electroconvulsive therapy (ECT)? Select one that does not apply.

• A. Short-term memory loss
• B. Headache
• C. Confusion
• D. Tardive dyskinesia

Correct answer: D

Rationale: Potential side effects of ECT include short-term memory loss, headache, confusion, and nausea. Tardive dyskinesia is not a side effect of ECT; it is associated with long-term use of antipsychotic medications, particularly antipsychotics that block dopamine receptors over time. ECT is primarily used for severe depression, bipolar disorder, and certain psychotic disorders. The other choices, short-term memory loss, headache, and confusion, are known side effects of ECT and are usually short-term and manageable.

3. Which medication would the nurse least likely use to provide immediate intervention for an angry psychotic client?

• A. Lithium
• B. Alprazolam
• C. Diphenhydramine
• D. Haloperidol

Correct answer: B

Rationale: Alprazolam is a benzodiazepine commonly used for anxiety disorders. While it may help calm an individual, it is not typically the first-line choice for managing acute agitation in a psychotic client. Haloperidol, on the other hand, is a typical antipsychotic medication often used for immediate intervention in psychiatric emergencies involving aggression or psychosis.

4. Ted, a former executive, is now unemployed due to manic episodes at work. He was diagnosed with bipolar I 8 years ago. Ted has a history of IV drug abuse, which resulted in hepatitis C. He is taking his lithium exactly as scheduled, a fact that both Ted's wife and his blood tests confirm. To reduce Ted's mania, the psychiatric nurse practitioner recommends:

• A. Clonazepam (Klonopin)
• B. Fluoxetine (Prozac)
• C. Electroconvulsive therapy (ECT)
• D. Lurasidone (Latuda)

Correct answer: C

Rationale: Electroconvulsive therapy (ECT) can be an effective treatment for reducing mania in patients with bipolar disorder who have not responded to medication. In Ted's case, where he has a history of bipolar I disorder, lithium treatment, and manic episodes, ECT may be recommended by the psychiatric nurse practitioner to help manage his symptoms.

5. Which is an example of the ego defense mechanism of regression?

• A. A mother blames the teacher for her child's failure in school.
• B. A teenager becomes hysterical after seeing a friend killed in a car accident.
• C. A woman wants to marry a man exactly like her beloved father.
• D. An adult throws a temper tantrum when he does not get his own way.

Correct answer: D

Rationale: The correct answer is D. Regression involves reverting to an earlier stage of development for comfort. In this case, an adult throwing a temper tantrum is regressing to a childlike behavior when faced with not getting their way, which is a form of seeking comfort associated with earlier development. Choices A, B, and C do not exemplify regression. Blaming the teacher, becoming hysterical after a traumatic event, or seeking a partner similar to a beloved father are not instances of reverting to earlier developmental stages to cope with stress or conflict.

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