Nursing Elites

1. When developing a care plan for a patient with generalized anxiety disorder (GAD), which short-term goal is most appropriate?

• A. The patient will experience no episodes of anxiety within the next week.
• B. The patient will learn and practice relaxation techniques.
• C. The patient will avoid all anxiety-provoking situations.
• D. The patient will be medication-free within a month.

Correct answer: B

Rationale: Option B, 'The patient will learn and practice relaxation techniques,' is the most appropriate short-term goal for managing generalized anxiety disorder. Teaching relaxation techniques can help the patient develop coping mechanisms and reduce anxiety levels in the immediate future, making it a realistic and beneficial goal. Options A and C are not feasible in the short term as complete elimination of anxiety episodes or avoidance of all anxiety-provoking situations may not be achievable or practical within a week. Option D is not a suitable short-term goal as it overlooks the potential need for medication in managing generalized anxiety disorder.

2. James is a 42-year-old patient with schizophrenia. He approaches you as you arrive for the day shift and anxiously reports, ‘Last night, demons came to my room and tried to rape me.’ Which response would be most therapeutic?

• A. There are no such things as demons. What you saw were hallucinations.
• B. It is not possible for anyone to enter your room at night. You are safe here.
• C. You seem very upset. Please tell me more about what you experienced last night.
• D. That must have been very frightening, but we’ll check on you at night and you’ll be safe.

Correct answer: C

Rationale: Choice C is the most therapeutic response as it acknowledges the patient’s feelings, shows empathy, and encourages further expression of his experiences. By actively listening and inviting the patient to share more details, the healthcare provider provides a supportive environment that can help the patient feel understood and validated. Option A dismisses the patient's experience and can make him feel unheard. Option B denies the patient's reality and can increase his distress. Option D, while offering reassurance, does not address the patient's emotional state or encourage further communication.

3. A 32-year-old female patient is diagnosed with generalized anxiety disorder (GAD). Which behavior would the nurse expect to observe?

• A. Complains of persistent and excessive worry.
• B. Frequently fidgets and has difficulty sitting still.
• C. Exhibits ritualistic behaviors.
• D. Reports periods of derealization.

Correct answer: A

Rationale: In generalized anxiety disorder (GAD), individuals often experience persistent and excessive worry about various aspects of their life. This worry is difficult to control and is disproportionate to the actual source of concern. The other options describe behaviors more commonly associated with other anxiety disorders like social anxiety disorder (frequent fidgeting and difficulty sitting still), obsessive-compulsive disorder (ritualistic behaviors), and depersonalization/derealization disorder (periods of derealization). Therefore, the correct behavior to expect in a patient with GAD is persistent and excessive worry.

4. A patient with borderline personality disorder is admitted to the psychiatric unit. Which behavior is most characteristic of this disorder?

• A. Avoiding social interactions due to fear of rejection.
• B. Engaging in impulsive and self-destructive behaviors.
• C. Having a grandiose sense of self-importance.
• D. Exhibiting a pattern of unstable relationships.

Correct answer: B

Rationale: Borderline personality disorder is characterized by impulsivity and self-destructive behaviors, such as substance abuse, reckless driving, and self-harm. These behaviors are often used to cope with intense emotional distress and are a key feature of this disorder. While individuals with borderline personality disorder may also struggle with unstable relationships, the hallmark feature that sets it apart is the impulsivity and self-destructive behaviors. Avoiding social interactions due to fear of rejection is more characteristic of avoidant personality disorder. Having a grandiose sense of self-importance is a feature of narcissistic personality disorder.

5. What is the primary benefit of using cognitive-behavioral therapy (CBT) for treating anxiety disorders?

• A. It focuses on long-term use of medications.
• B. It helps patients understand and change their thought patterns.
• C. It primarily addresses childhood traumas.
• D. It encourages patients to avoid anxiety-provoking situations.

Correct answer: B

Rationale: The primary benefit of using cognitive-behavioral therapy (CBT) for treating anxiety disorders is that it helps patients understand and change their thought patterns. By addressing maladaptive thought processes and behaviors, CBT can effectively reduce anxiety symptoms and improve coping mechanisms. This approach empowers individuals to develop healthier responses to anxiety triggers, leading to long-lasting benefits beyond solely relying on medications or avoiding anxiety-provoking situations. Choices A, C, and D are incorrect because CBT does not primarily focus on long-term use of medications, addressing childhood traumas, or encouraging avoidance of anxiety-provoking situations. While medications may be used in conjunction with CBT, the main focus of CBT is on cognitive restructuring and behavioral interventions to alleviate anxiety symptoms.

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