Nursing Elites

1. A client is diagnosed with somatic symptom disorder. Which question will help the nurse develop nursing diagnoses for this client’s plan of care?

• A. Are you satisfied with your appearance?
• B. Do you take medication for anxiety as prescribed?
• C. When did you last feel detached from your environment?
• D. How long have you had these memory problems?

Correct answer: B

Rationale: In clients with somatic symptom disorder, it is crucial to assess their adherence to medication for anxiety as prescribed. This question helps the nurse understand the client's treatment compliance, which can impact the development of nursing diagnoses and the overall plan of care. Monitoring medication adherence is essential in managing the client's symptoms and improving outcomes.

2. Which statement reflects an accurate understanding of the concepts of mental health and mental illness?

• A. The concepts are rigid and religiously based.
• B. The concepts are multidimensional and culturally defined.
• C. The concepts are universal and unchanging.
• D. The concepts are unidimensional and fixed.

Correct answer: B

Rationale: Understanding mental health and mental illness as multidimensional and culturally defined is essential for healthcare professionals. Mental health varies across cultures and is influenced by various dimensions such as biological, psychological, social, and spiritual factors. Recognizing these differences helps in providing culturally competent care and understanding the diverse expressions of mental health and illness. Choice A is incorrect because mental health and mental illness are not rigid or solely based on religion. Choice C is incorrect because mental health and mental illness are not universally experienced in the same way and can change over time. Choice D is incorrect because mental health and mental illness are not unidimensional; they involve various factors and are not fixed in nature.

3. Which client statement indicates an understanding of the education provided about the antidepressant medication sertraline (Zoloft)?

• A. I should take this medication on an empty stomach.
• B. It may take several weeks for this medication to be effective.
• C. I can stop taking this medication when I feel better.
• D. I should avoid taking this medication with other medications.

Correct answer: B

Rationale: Choice B is the correct answer. It is crucial for clients to understand that sertraline (Zoloft) may take several weeks to show its full effects. Patients should be informed about this delay in onset of action to set realistic expectations and adhere to the treatment plan. This education helps prevent premature discontinuation of the medication due to perceived lack of efficacy. Choices A, C, and D are incorrect. Choice A is inaccurate because sertraline (Zoloft) should be taken with food to reduce the risk of gastrointestinal side effects. Choice C is incorrect because abruptly stopping the medication can lead to withdrawal symptoms and worsening of the condition. Choice D is inaccurate as there are specific medications that should be avoided with sertraline, but a general statement to avoid all other medications is overly broad and not necessary.

4. A client with post-traumatic stress disorder (PTSD) is experiencing flashbacks. Which of the following interventions should the nurse implement?

• A. Encourage the client to ignore the flashbacks.
• B. Stay with the client and offer reassurance.
• C. Instruct the client to avoid discussing the traumatic event.
• D. Encourage the client to engage in group therapy.

Correct answer: B

Rationale: During a flashback, it is essential for the nurse to stay with the client and offer reassurance. This approach can help the client feel safe and supported during a distressing experience. Encouraging the client to ignore the flashbacks may lead to increased anxiety and distress. Instructing the client to avoid discussing the traumatic event can hinder the therapeutic process of addressing and processing the trauma. While group therapy can be beneficial, it may not be the immediate intervention needed during a flashback.

5. After a client with major depressive disorder undergoes electroconvulsive therapy (ECT), which of the following is a priority assessment for the nurse?

• A. Monitoring for signs of infection
• B. Monitoring for signs of respiratory distress
• C. Monitoring for signs of hypotension
• D. Monitoring for signs of bleeding

Correct answer: B

Rationale: The priority assessment for the nurse after a client undergoes electroconvulsive therapy (ECT) is monitoring for signs of respiratory distress. This is crucial due to the potential risk of complications from anesthesia, such as airway compromise or respiratory depression. Prompt identification and intervention in case of respiratory distress are essential to ensure the client's safety and well-being. Monitoring for signs of infection (Choice A) is important but not the priority immediately post-ECT. Hypotension (Choice C) and bleeding (Choice D) are also potential concerns but assessing respiratory distress takes precedence due to the immediate risk it poses to the client's well-being.

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