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. A client has been diagnosed with illness anxiety disorder. Which of the following behaviors should the nurse expect?

• A. Preoccupation with having a serious illness
• B. Fear of social situations
• C. Dramatic expressions of emotion
• D. Preoccupation with a perceived physical defect

Correct answer: A

Rationale: The correct answer is A: Preoccupation with having a serious illness. Illness anxiety disorder, formerly known as hypochondriasis, is characterized by a preoccupation with having or acquiring a serious illness, despite medical reassurance. This preoccupation leads individuals to misinterpret normal bodily sensations as signs of a severe illness, causing distress and impairment in daily functioning. Choices B, C, and D are incorrect because fear of social situations, dramatic expressions of emotion, and preoccupation with a perceived physical defect are not typical behaviors associated with illness anxiety disorder.

3. A woman was abducted and raped at gunpoint by an unknown assailant. When found, she was confused and disoriented. The nurse makes the following observations about the client. She is talking rapidly in disjointed phrases, is unable to concentrate, and is indecisive when asked to make simple decisions. The client's level of anxiety can be assessed as

• A. moderate
• B. severe
• C. mild
• D. nonexistent

Correct answer: B

Rationale: The client's presentation, including rapid and disjointed speech, inability to concentrate, and indecisiveness, are indicative of severe anxiety. These symptoms suggest a high level of distress and impairment in cognitive functioning, which aligns with severe anxiety rather than mild or moderate levels. The traumatic experience of being abducted and raped at gunpoint would likely contribute to such a severe level of anxiety.

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

• A. Encourage participation in activities
• B. Promote adequate nutrition and hydration
• C. Monitor for suicidal ideation
• D. Discourage verbalization of feelings

Correct answer: D

Rationale: In caring for a client with bipolar disorder in a depressive episode, the nurse should implement interventions that promote mental well-being. Encouraging participation in activities, promoting adequate nutrition and hydration, and monitoring for suicidal ideation are all essential components of care. Discouraging verbalization of feelings is counterproductive as it hinders the therapeutic process and communication, which are crucial for the client's emotional expression and recovery.

5. A client with a history of alcohol use disorder is admitted to the hospital. Which assessment finding would indicate early alcohol withdrawal?

• A. Bradycardia
• B. Hypotension
• C. Diaphoresis
• D. Hypothermia

Correct answer: C

Rationale: In a client experiencing early alcohol withdrawal, one of the key assessment findings is diaphoresis (excessive sweating). This is due to autonomic hyperactivity commonly seen during this phase, along with other signs like tremors and tachycardia. Bradycardia (slow heart rate), hypotension (low blood pressure), and hypothermia (low body temperature) are not typically associated with early alcohol withdrawal, making them incorrect choices.

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