Nursing Elites

1. A client has been diagnosed with paranoid personality disorder. Which of the following behaviors should the nurse expect?

• A. Distrust of others
• B. Reluctance to confide in others
• C. Suspiciousness of others
• D. Jealousy of others

Correct answer: A

Rationale: Individuals with paranoid personality disorder commonly display a pervasive distrust of others. They often interpret benign actions of others as hostile or malicious, leading to suspicion and a belief that others have malevolent intentions. While choices B, C, and D may be present in individuals with different personality disorders or issues, distrust of others is a hallmark feature of paranoid personality disorder, making it the correct behavior to expect in these clients.

2. Ted, a former executive, is now unemployed due to manic episodes at work. He was diagnosed with bipolar I 8 years ago. Ted has a history of IV drug abuse, which resulted in hepatitis C. He is taking his lithium exactly as scheduled, a fact that both Ted's wife and his blood tests confirm. To reduce Ted's mania, the psychiatric nurse practitioner recommends:

• A. Clonazepam (Klonopin)
• B. Fluoxetine (Prozac)
• C. Electroconvulsive therapy (ECT)
• D. Lurasidone (Latuda)

Correct answer: C

Rationale: Electroconvulsive therapy (ECT) can be an effective treatment for reducing mania in patients with bipolar disorder who have not responded to medication. In Ted's case, where he has a history of bipolar I disorder, lithium treatment, and manic episodes, ECT may be recommended by the psychiatric nurse practitioner to help manage his symptoms.

3. When an individual uses the defense mechanism of displacement after the boss openly disagrees with suggestions, what behavior would be expected from this individual?

• A. The individual assertively confronts the boss
• B. The individual leaves the staff meeting to work out in the gym
• C. The individual criticizes a coworker
• D. The individual takes the boss out to lunch

Correct answer: C

Rationale: The correct answer is C. The individual using the defense mechanism of displacement would criticize a coworker after being confronted by the boss. Displacement involves transferring feelings from one target to a neutral or less-threatening target, hence the individual criticizing a coworker instead of directly confronting the boss. Choices A, B, and D are incorrect. Choice A is incorrect because the individual is not likely to assertively confront the boss when using displacement. Choice B is incorrect as leaving the meeting to work out in the gym is not a typical response when displacement is used. Choice D is incorrect as taking the boss out to lunch does not align with the concept of displacement, which involves redirecting emotions onto another target.

4. A healthcare provider is caring for a client diagnosed with schizophrenia. Which intervention is most appropriate to address the client's delusions?

• A. Challenge the client's delusions directly.
• B. Provide evidence to disprove the delusions.
• C. Acknowledge the client's feelings without reinforcing the delusions.
• D. Ignore the client's delusions.

Correct answer: C

Rationale: When caring for a client with schizophrenia experiencing delusions, the most appropriate intervention is to acknowledge the client's feelings without reinforcing the delusions. This approach helps maintain trust and communication, fostering a therapeutic relationship. Challenging the delusions directly can lead to increased distress and resistance from the client. Providing evidence to disprove the delusions may not be effective due to the deeply ingrained nature of the client's beliefs. Ignoring the delusions may make the client feel dismissed or unheard, which can hinder the therapeutic process.

5. A physically and emotionally healthy client has just been fired. During a routine office visit, he states to a nurse: 'Perhaps this was the best thing to happen. Maybe I'll look into pursuing an art degree.' How should the nurse characterize the client's appraisal of the job loss stressor?

• A. Irrelevant
• B. Harm/loss
• C. Threatening
• D. Challenging

Correct answer: D

Rationale: The client's statement indicates that he views the job loss as an opportunity for growth and a new direction in life rather than a threat or harm/loss. He sees it as a challenge and is considering it positively, demonstrating resilience and adaptability in the face of adversity. Choice A, 'Irrelevant,' is incorrect as the client's response shows relevance and a positive outlook. Choice B, 'Harm/loss,' is incorrect as the client does not express a sense of harm or loss but rather opportunity. Choice C, 'Threatening,' is incorrect as the client's response does not convey fear or threat but rather a positive reframe of the situation.

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