Nursing Elites

1. In an acute mental health facility, a nurse is communicating with a client. The client states, “I can’t sleep. I stay up all night.” The nurse responds, “You are having difficulty sleeping?” Which of the following therapeutic communication techniques is the nurse demonstrating?

• A. Offering general leads
• B. Summarizing
• C. Focusing
• D. Restating

Correct answer: D

Rationale: The nurse is using the restating technique, where the nurse paraphrases or repeats the main idea expressed by the client to show understanding and encourage further communication. Restating helps clarify the client's message and fosters a therapeutic relationship. Choice A, offering general leads, involves encouraging the client to continue talking with nonverbal or minimal verbal prompts. Summarizing (Choice B) involves condensing and organizing the client's message. Focusing (Choice C) involves centering the conversation on a key element or topic.

2. A patient diagnosed with dissociative identity disorder has been undergoing therapy for several months. Which outcome indicates that the patient is progressing in therapy?

• A. The patient has developed a strong therapeutic relationship with the therapist.
• B. The patient’s different personalities are beginning to merge.
• C. The patient is able to recall traumatic events without dissociating.
• D. The patient reports fewer gaps in memory.

Correct answer: B

Rationale: In dissociative identity disorder, the merging of different personalities is a crucial indicator of progress in therapy. As the different identities merge, it signifies that the patient is integrating fragmented aspects of their self, leading to a more cohesive sense of identity and a reduction in dissociative symptoms. This process is a significant therapeutic milestone in the treatment of dissociative identity disorder as it promotes internal cohesion and decreases internal conflict. Choices A, C, and D are incorrect because while developing a strong therapeutic relationship, recalling traumatic events without dissociating, and reporting fewer gaps in memory are important aspects of therapy, the merging of different personalities is specifically indicative of substantial progress in treating dissociative identity disorder.

3. What must be considered when preparing the teaching plan for a patient diagnosed with bipolar disorder who is being prescribed lithium therapy?

• A. Caffeine and alcohol can affect lithium levels.
• B. Lithium should be taken with meals to avoid gastrointestinal distress.
• C. Regular blood tests are required to monitor lithium levels.
• D. Lithium can cause weight gain.

Correct answer: C

Rationale: When preparing a teaching plan for a patient prescribed lithium therapy for bipolar disorder, it is crucial to emphasize the need for regular blood tests to monitor lithium levels. Monitoring levels is essential to ensure the drug's effectiveness and to manage potential side effects. While factors like caffeine and alcohol intake, taking lithium with meals, and the risk of weight gain may be relevant considerations, the primary focus should be on the necessity of regular blood tests for effective management of lithium therapy. Therefore, option C is the correct choice as it addresses a critical aspect of lithium therapy management.

4. During the working phase of a therapeutic relationship, a client with methamphetamine use disorder displays transference behavior. Which action by the client indicates transference behavior?

• A. The client asks the nurse if they will go out to dinner together
• B. The client accuses the nurse of being controlling just like an ex-partner
• C. The client reminds the nurse of a friend who died from substance toxicity
• D. The client becomes angry and threatens to engage in self-harm

Correct answer: B

Rationale: Transference occurs when a client projects feelings, often unconscious, onto the nurse that are associated with significant figures in their past or present life. In this scenario, the client accusing the nurse of being controlling like an ex-partner demonstrates transference behavior by attributing characteristics of someone from their past onto the nurse. Choices A, C, and D do not reflect transference behavior. Choice A involves a social invitation, which is not necessarily transference. Choice C is more related to countertransference as it triggers memories in the nurse, not the client. Choice D describes aggressive behavior and self-harm threats, which are not indicative of transference.

5. A healthcare professional is assessing a patient with anorexia nervosa. Which finding is most concerning?

• A. Mild bradycardia
• B. Electrolyte imbalances
• C. Slight hypotension
• D. Lanugo

Correct answer: B

Rationale: Electrolyte imbalances are a critical concern in patients with anorexia nervosa due to the potential for severe complications such as cardiac arrhythmias, muscle weakness, and neurological disturbances. Prompt identification and management of electrolyte imbalances are essential to prevent life-threatening outcomes.

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