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. Gilbert, age 19, is described by his parents as a ‘moody child’ with an onset of odd behavior at age 14, which caused Gilbert to suffer academically and socially. Gilbert has lost the ability to complete household chores, is reluctant to leave the house, and is obsessed with the locks on the windows and doors. Due to Gilbert’s early and slow onset of what is now recognized as schizophrenia, his prognosis is considered:

• A. Favorable with medication
• B. In the relapse stage
• C. Improvable with psychosocial interventions
• D. To have a less positive outcome

Correct answer: D

Rationale: A person like Gilbert, with an early and slow onset of schizophrenia along with severe symptoms such as loss of daily functioning and obsessions, is likely to have a less positive outcome. Early and severe symptoms are often associated with a more chronic and debilitating course of schizophrenia, which can make treatment and recovery more challenging. Therefore, Gilbert's prognosis is considered to have a less positive outcome. Choices A, B, and C are incorrect because Gilbert's condition, with its early onset and severe symptoms impacting daily life, suggests a more challenging prognosis that is less likely to be favorable with just medication or psychosocial interventions. Being in the relapse stage is not the primary concern here; the focus is on the overall outcome which is expected to be less positive given the early and severe nature of Gilbert's symptoms.

3. A patient with generalized anxiety disorder (GAD) is prescribed buspirone. Which statement by the patient indicates a need for further teaching?

• A. I can take this medication on an as-needed basis.
• B. It may take a few weeks to feel the full effect of this medication.
• C. This medication has a lower risk of dependency compared to benzodiazepines.
• D. I should take this medication consistently every day.

Correct answer: A

Rationale: The correct answer is A. Buspirone is not meant to be taken on an as-needed basis. It should be taken consistently every day to achieve the desired therapeutic effect. Choice B is correct as it accurately reflects that buspirone may take a few weeks to reach its full effect. Choice C is also correct as buspirone indeed has a lower risk of dependency compared to benzodiazepines. Choice D is correct because taking buspirone consistently every day is the appropriate way to use this medication.

4. When working with a patient diagnosed with posttraumatic stress disorder (PTSD), which therapeutic approach is most appropriate?

• A. Encouraging the patient to avoid discussing the traumatic event.
• B. Using exposure therapy to help the patient confront their fears.
• C. Advising the patient to focus on positive thoughts.
• D. Suggesting that the patient keep busy to distract from traumatic memories.

Correct answer: B

Rationale: Exposure therapy is an evidence-based treatment for PTSD that involves gradually exposing the patient to their traumatic memories in a safe and controlled environment. This approach helps individuals confront and process their fears, reducing the impact of the traumatic event over time. Avoiding discussing the trauma (choice A) may lead to avoidance behaviors and hinder recovery. Focusing on positive thoughts (choice C) may provide temporary relief but does not address the underlying trauma. Keeping busy to distract from memories (choice D) is a form of avoidance that does not help in processing the traumatic experiences. Therefore, using exposure therapy (choice B) is the most appropriate approach to effectively treat PTSD.

5. 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: D

Rationale: Lurasidone (Latuda) is an atypical antipsychotic medication commonly used in the treatment of bipolar disorder. It can help manage symptoms of mania by stabilizing mood and reducing the intensity of manic episodes. Given Ted's history of bipolar I disorder and the need to address his manic symptoms, Lurasidone (Latuda) is a suitable recommendation by the psychiatric nurse practitioner to aid in managing Ted's condition effectively.

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