Nursing Elites

1. A client is diagnosed with somatic symptom disorder. Which of the following behaviors should the nurse expect?

• A. Excessive worry about physical symptoms
• B. Fear of gaining weight
• C. Frequent visits to healthcare providers
• D. Persistent depressive mood

Correct answer: C

Rationale: Individuals with somatic symptom disorder often exhibit frequent visits to healthcare providers due to their excessive worry about physical symptoms. They seek reassurance and explanations for their perceived medical issues, even when there is no organic basis for their complaints. This behavior is a characteristic feature of somatic symptom disorder and distinguishes it from other conditions. Choices A, B, and D are incorrect. Excessive worry about physical symptoms may occur but it is not the primary behavior associated with this disorder. Fear of gaining weight is more characteristic of eating disorders, and persistent depressive mood is more indicative of mood disorders rather than somatic symptom disorder.

2. Kyle, a patient with schizophrenia, began taking the first-generation antipsychotic haloperidol (Haldol) last week. One day you find him sitting very stiffly and not moving. He is diaphoretic, and when you ask if he is okay, he seems unable to respond verbally. His vital signs are: BP 170/100, P 110, T 104.2°F. What is the priority nursing intervention? Select one that does not apply.

• A. Hold his medication and contact his prescriber.
• B. Wipe him with a washcloth wet with cold water or alcohol.
• C. Administer a medication such as benztropine IM to correct this dystonic reaction.
• D. Reassure him that although there is no treatment for his tardive dyskinesia, it will pass.

Correct answer: C

Rationale: The patient's symptoms, including stiffness, diaphoresis, inability to respond verbally, and vital sign abnormalities, are indicative of neuroleptic malignant syndrome (NMS), a serious and potentially life-threatening side effect of antipsychotic medications. Administering a medication such as benztropine intramuscularly is the priority to address the dystonic reaction associated with NMS. This intervention can help alleviate symptoms and prevent further complications. Holding the medication and contacting the prescriber may be necessary but addressing the acute symptoms takes precedence. Wiping the patient with a cold washcloth or alcohol would not address the underlying medical emergency. Reassuring the patient about tardive dyskinesia is irrelevant and not the immediate concern in this scenario.

3. Which of the following are therapeutic communication techniques that a healthcare professional can use when interacting with clients? Select one that doesn't apply.

• A. Using silence
• B. Offering self
• C. Giving advice
• D. Providing reassurance

Correct answer: C

Rationale: Therapeutic communication techniques aim to promote understanding and trust between the professional and the client. Using silence allows the client to process thoughts, feelings, and information. Offering self involves making oneself available and showing empathy. Providing reassurance helps instill confidence. However, giving advice can sometimes be non-therapeutic as it may undermine the client's autonomy and decision-making process.

4. 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: Showing interest in the app can build rapport and allow for evaluation of its effectiveness.

5. Pablo is a homeless adult who has no family connection. Pablo passed out on the street, and emergency medical services took him to the hospital where he expresses a wish to die. The physician recognizes evidence of substance use problems and mental health issues and recommends inpatient treatment for Pablo. What is the rationale for this treatment choice? Select one that doesn't apply.

• A. Intermittent supervision is available in inpatient settings.
• B. He requires stabilization of multiple symptoms.
• C. How do you feel about talking to a mental health counselor?
• D. Medication adherence will be mandated.

Correct answer: D

Rationale: The correct answer is D because medication adherence being mandated is not a primary rationale for inpatient treatment. The main reasons for recommending inpatient treatment in this scenario include the need for stabilization of multiple symptoms, addressing nutritional and self-care needs, and ensuring safety due to the imminent danger of self-harm. Inpatient settings provide a more intensive level of care and supervision to address these complex issues effectively.

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