Nursing Elites

1. A fourth-grade student teases and makes jokes about a cute girl in his class. This behavior should be identified by a professional as indicative of which defense mechanism?

• A. Displacement
• B. Projection
• C. Reaction formation
• D. Sublimation

Correct answer: C

Rationale: The professional should identify that the student is using reaction formation as a defense mechanism. Reaction formation involves expressing opposite thoughts or behaviors to prevent undesirable thoughts from being expressed. In this scenario, the student's teasing and joking behavior towards the girl can be seen as a way to cover up or mask his true feelings or desires towards her. Displacement involves redirecting emotions from the original source to a substitute target; Projection involves attributing one's undesirable feelings to others; Sublimation involves channeling unacceptable impulses into socially acceptable activities. Therefore, in this case, the student's behavior aligns most closely with reaction formation.

2. Which statement is an example of reflection?

• A. I think this feeling will pass.
• B. So you are saying that life has no meaning.
• C. I'm not sure I understand what you mean.
• D. You look sad.

Correct answer: B

Rationale: The correct answer is B. Reflection involves restating the patient's words or feelings to show understanding and encourage further discussion. Choice B restates the patient's statement, demonstrating active listening and empathy.

3. A client has been taking lithium for several years with good symptom control. The client presents in the emergency department with blurred vision, tinnitus, and severe diarrhea. Which lithium level should the nurse correlate with these symptoms?

• A. 3.7
• B. 1.7
• C. 2.6
• D. 1.3

Correct answer: B

Rationale: Symptoms such as blurred vision, tinnitus, and severe diarrhea are indicative of lithium toxicity. A lithium level of 1.7 is within the toxic range. When clients present with these symptoms, it is crucial for the nurse to correlate them with elevated lithium levels to ensure timely intervention and prevent further complications.

4. A 33-year-old female diagnosed with bipolar I disorder has been functioning well on lithium for 11 months. At her most recent checkup, the psychiatric nurse practitioner states, 'You are ready to enter the maintenance therapy stage, so at this time I am going to adjust your dosage by prescribing:'

• A. A higher dosage
• B. Once-weekly dosing
• C. A lower dosage
• D. A different drug

Correct answer: C

Rationale: During the maintenance therapy stage for bipolar I disorder, it is common to lower the dosage of lithium to prevent side effects while still maintaining stability. Lowering the dosage helps to find the lowest effective dose that can still manage symptoms effectively with minimal side effects.

5. A 10-year-old boy breaks his mother's vase while playing. When the mother asks who broke the vase, the little boy says that his sister did it. The little boy is exhibiting which defense mechanism?

• A. Projection
• B. Displacement
• C. Dissociation
• D. Sublimation

Correct answer: A

Rationale: Projection is a defense mechanism where one attributes their own unacceptable thoughts, feelings, or impulses onto another person. In this scenario, the little boy is projecting his actions onto his sister by falsely claiming she broke the vase. Displacement involves transferring emotions from the original source to a substitute target. Dissociation is a disconnection between thoughts, identity, consciousness, and memory. Sublimation is the redirection of unacceptable impulses into socially acceptable activities.

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