Nursing Elites

1. A client tells the RN that he has an IQ of 400+ and is a genius and an inventor. He also reports that he is married to a female movie star and thinks that his brother wants a sexual relationship with her. What is the priority nursing problem for admission to the psychiatric unit?

• A. Ineffective sexual patterns.
• B. Impaired environmental interpretation.
• C. Disturbed sensory perception.
• D. Compromised family coping.

Correct answer: C

Rationale: The priority nursing problem for admission to the psychiatric unit is 'Disturbed sensory perception.' This choice is correct because the client's delusional beliefs about having an IQ of 400+, being a genius and an inventor, being married to a movie star, and suspecting his brother of wanting a sexual relationship with her indicate a significant disturbance in sensory perception. The client's perceptions are not based in reality, indicating a need for immediate intervention to address these distorted beliefs. Choices A, B, and D are incorrect: 'Ineffective sexual patterns' is not the priority as the client's delusions go beyond just sexual relationships, 'Impaired environmental interpretation' does not capture the primary issue of distorted perceptions, and 'Compromised family coping' is not the priority concern in this scenario compared to the severe sensory perception disturbances displayed by the client.

2. Carolina is surprised when her patient does not show for a regularly scheduled appointment. When contacted, the patient states, 'I don't need to come see you anymore. I have found a therapy app on my phone that I love.' How should Carolina respond to this news?

• A. That sounds exciting, would you be willing to visit and show me the app?
• B. At this time, there is no real evidence that the app can replace our therapy.
• C. I am not sure that is a good idea right now; we are so close to progress.
• D. Why would you think that is a better option than meeting with me?

Correct answer: A

Rationale: Carolina should respond with choice A as it shows interest and willingness to understand the patient's new approach. By asking the patient to show the app, Carolina demonstrates openness to exploring the patient's perspective and the technology they find helpful. Choice B is incorrect as it appears dismissive, failing to acknowledge the patient's autonomy in choosing an alternative therapy method. Choice C is also inappropriate as it undermines the patient's decision-making and progress achieved so far. Choice D comes off as confrontational and judgmental, which could lead to the patient feeling defensive and less likely to engage in a constructive conversation.

3. A client with post-traumatic stress disorder (PTSD) is struggling with flashbacks and nightmares. Which therapeutic approach should the nurse include in the care plan?

• A. Cognitive-behavioral therapy.
• B. Electroconvulsive therapy (ECT).
• C. Medication management only.
• D. Relaxation training and mindfulness.

Correct answer: A

Rationale: Corrected Question: A client with post-traumatic stress disorder (PTSD) experiencing flashbacks and nightmares would benefit from cognitive-behavioral therapy (CBT) in the care plan. CBT is an evidence-based therapeutic approach that focuses on identifying and changing negative thought patterns and behaviors associated with PTSD symptoms. This helps the client learn coping strategies to manage distressing symptoms like flashbacks and nightmares.\nIncorrect Choices Rationale: B) Electroconvulsive therapy (ECT) is not indicated for PTSD and is typically used for severe depression that has not responded to other treatments. C) Medication management alone may not address the underlying cognitive and behavioral aspects of PTSD. D) Relaxation training and mindfulness can be helpful as adjunctive therapies but may not be as effective as CBT in specifically targeting and modifying PTSD symptoms.

4. A woman brings her 48-year-old husband to the outpatient psychiatric unit and describes his behavior to the admitting nurse. She states that he has been sleepwalking, cannot remember who he is, and exhibits multiple personalities. The nurse knows that these behaviors are often associated with:

• A. Post-traumatic stress disorder.
• B. Panic disorder.
• C. Dissociative identity disorder.
• D. Obsessive-compulsive disorder.

Correct answer: C

Rationale: The correct answer is C: Dissociative identity disorder. Dissociative identity disorder (DID) is characterized by the presence of two or more distinct personality states or identities, along with memory gaps beyond ordinary forgetfulness. The description of the husband sleepwalking, not recognizing his identity, and exhibiting multiple personalities aligns with the symptoms of DID. Post-traumatic stress disorder (PTSD) (Choice A) involves re-experiencing traumatic events, panic disorder (Choice B) is characterized by recurrent panic attacks, and obsessive-compulsive disorder (OCD) (Choice D) involves obsessions and compulsions. These conditions do not typically present with the specific symptoms described in the scenario.

5. A client who has a history of bipolar disorder is recovering from a manic episode and is now experiencing depressive symptoms. Which action should the nurse take first?

• A. Assess the client for suicidal ideation.
• B. Provide a detailed schedule of daily activities.
• C. Discuss the importance of medication adherence.
• D. Encourage the client to engage in group therapy.

Correct answer: A

Rationale: Assessing for suicidal ideation is the priority when a client with bipolar disorder is transitioning from a manic episode to a depressive phase. Suicidal ideation is a critical concern during depressive episodes, and ensuring the client's safety is the top priority. Providing a detailed schedule of daily activities (Choice B) may be helpful but is not the immediate priority over assessing for suicidal ideation. Discussing the importance of medication adherence (Choice C) and encouraging group therapy (Choice D) are essential components of care but are secondary to ensuring the client's safety in the context of potential suicidal ideation.

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