Nursing Elites

1. A nurse is assessing a patient with schizophrenia who is experiencing delusions. Which intervention is most appropriate?

• A. Agree with the patient's delusions to avoid confrontation.
• B. Encourage the patient to explore the basis of the delusions.
• C. Engage the patient in reality-based activities.
• D. Ask the patient to explain the delusions in detail.

Correct answer: C

Rationale: The most appropriate intervention when assessing a patient with schizophrenia experiencing delusions is to engage the patient in reality-based activities. This intervention helps distract the patient from the delusions and reorients them to the present, promoting grounding in reality. Choice A is incorrect because agreeing with delusions can reinforce them and hinder treatment. Choice B may exacerbate the delusions by delving deeper into their basis. Choice D may not be beneficial as it focuses solely on the delusions without addressing the need to ground the patient in reality.

2. Which should the individual recognize as an example of the defense mechanism of repression?

• A. A student aware of the need to study for tomorrow's test goes to a movie instead.
• B. A woman whose son was killed in Iraq does not believe the military report.
• C. A man who is unhappily married goes to school to become a marriage counselor.
• D. A woman was raped when she was 12 and no longer remembers the incident.

Correct answer: D

Rationale: Repression is a defense mechanism where distressing thoughts, feelings, or memories are pushed out of conscious awareness to protect the individual from emotional pain. In this scenario, the woman's inability to recall the traumatic event of being raped at the age of 12 indicates repression in action. Choices A, B, and C do not represent repression. Choice A reflects procrastination, choice B suggests denial, and choice C indicates sublimation as the man is channeling his unhappiness into a constructive pursuit.

3. A healthcare provider is providing care for a patient with attention-deficit/hyperactivity disorder (ADHD). Which therapeutic intervention is most effective for this condition?

• A. Group therapy
• B. Cognitive-behavioral therapy
• C. Psychoanalysis
• D. Family therapy

Correct answer: B

Rationale: Cognitive-behavioral therapy (CBT) is the most effective therapeutic intervention for managing ADHD symptoms. CBT helps individuals with ADHD develop coping strategies, improve focus, organization, and time management skills, and address behavioral challenges effectively. Group therapy might not provide the specific skills training needed for ADHD management. Psychoanalysis focuses on exploring deeper unconscious processes and may not be as practical for addressing ADHD symptoms. Family therapy can be beneficial for family dynamics but may not directly target individual ADHD symptoms as effectively as CBT.

4. At what point should the nurse determine that a client is at risk for developing a mental disorder?

• A. When thoughts, feelings, and behaviors are not reflective of the DSM-5 criteria
• B. When maladaptive responses to stress are coupled with interference in daily functioning
• C. When the client communicates significant distress
• D. When the client uses defense mechanisms as ego protection

Correct answer: B

Rationale: The nurse should determine that the client is at risk for mental disorder when responses to stress are maladaptive and interfere with daily functioning. The DSM-5 indicates that in order to be diagnosed with a mental disorder, there must be significant disturbance in cognition, emotion, regulation, or behavior that reflects a dysfunction in the psychological, biological or developmental processes underlying mental functioning. These disorders are usually associated with significant distress or disability in social, occupational, or other important activities. The client's ability to communicate distress would be considered a positive attribute.

5. A healthcare provider is providing education to the family of a client who has been diagnosed with bipolar disorder. Which of the following instructions should the healthcare provider include?

• A. The client should avoid all stressful situations.
• B. Encourage the client to get plenty of rest.
• C. Make sure the client takes prescribed medications regularly.
• D. Provide the client with information about support groups.

Correct answer: C

Rationale: The correct answer is C: 'Make sure the client takes prescribed medications regularly.' Consistent medication adherence is crucial in managing the symptoms and stabilizing mood in individuals with bipolar disorder. Choice A is incorrect because avoiding all stressful situations is often not feasible and not the primary treatment approach for bipolar disorder. Choice B, while important, is not as critical as ensuring medication compliance. Choice D is helpful but not as essential as medication adherence for the treatment of bipolar disorder.

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