Nursing Elites

1. In evaluating a client's response to stress, what would indicate a secondary appraisal of the stressful event?

• A. When the individual judges the event to be benign
• B. When the individual judges the event to be irrelevant
• C. When the individual judges the resources and skills needed to deal with the event
• D. When the individual judges the event to be pleasurable

Correct answer: C

Rationale: A secondary appraisal occurs when an individual evaluates the resources and skills required to cope with a stressful event. This type of appraisal focuses on the person's perceived ability to manage the situation. In contrast, choices A, B, and D do not involve the assessment of resources and skills. Choice A relates to a benign judgment of the event, choice B to an irrelevant judgment, and choice D to a pleasurable judgment, which are aspects of primary rather than secondary appraisals.

2. A client with generalized anxiety disorder (GAD) is being discharged. Which of the following instructions should the nurse include in the discharge teaching? Select one that does not apply.

• A. Practice relaxation techniques daily
• B. Avoid caffeine and alcohol
• C. Engage in regular physical activity
• D. Use benzodiazepines as the first line of treatment

Correct answer: D

Rationale: When discharging a client with GAD, it is important to provide instructions that promote holistic well-being and support without exacerbating the condition. Practicing relaxation techniques daily, avoiding caffeine and alcohol, and engaging in regular physical activity can help manage anxiety symptoms effectively. These strategies focus on self-care and healthy lifestyle choices. Seeking support from friends and family also plays a crucial role in maintaining mental health. However, using benzodiazepines as the first line of treatment is not recommended due to their potential for dependence and other associated risks. Non-pharmacological interventions and therapy are usually preferred as initial approaches in managing GAD. Therefore, the option 'D: Use benzodiazepines as the first line of treatment' is incorrect and should not be included in the discharge teaching for a client with GAD.

3. During an assessment, a nurse observes a client showing signs of moderate anxiety. Which symptom is not typically associated with moderate anxiety?

• A. Fidgeting
• B. Laughing inappropriately
• C. Palpitations
• D. Nail biting

Correct answer: C

Rationale: When assessing a client with moderate anxiety, the nurse should anticipate signs such as fidgeting, laughing inappropriately, and nail biting. These behaviors are common manifestations of increased stress levels. Palpitations, on the other hand, are more commonly associated with severe anxiety or panic attacks. Other symptoms of severe anxiety may include restlessness, difficulty concentrating, muscle tension, and sleep disturbances.

4. When assessing a client diagnosed with post-traumatic stress disorder (PTSD), which finding should the nurse expect?

• A. Hypervigilance
• B. Insomnia
• C. Flashbacks
• D. Suicidal ideation

Correct answer: A

Rationale: Clients with PTSD commonly exhibit symptoms such as hypervigilance, insomnia, flashbacks, difficulty concentrating, and increased irritability. Hypervigilance refers to an enhanced state of awareness and alertness, often seen in individuals with PTSD as they are constantly on guard for potential threats. Insomnia is a common sleep disturbance associated with PTSD, where individuals may have trouble falling or staying asleep. Flashbacks involve re-experiencing the traumatic event as if it is occurring in the present moment. Suicidal ideation, while a serious concern in mental health, is not a hallmark symptom specifically associated with PTSD. Therefore, the correct finding that the nurse should expect when assessing a client diagnosed with PTSD is hypervigilance.

5. What intervention should the nurse implement for a client with obsessive-compulsive disorder (OCD) performing ritualistic handwashing?

• A. Allow the client to continue the ritualistic behavior initially
• B. Immediately stop the client from performing the ritual
• C. Encourage the client to perform the ritual more quickly
• D. Provide a distraction to interrupt the ritual

Correct answer: A

Rationale: For a client with OCD performing ritualistic handwashing, the nurse should initially allow the client to continue the behavior. Abruptly stopping the behavior or providing a distraction can heighten the client's anxiety. Encouraging the client to perform the ritual more quickly does not address the underlying issue of OCD and may exacerbate their anxiety. Providing a distraction to interrupt the ritual may not be effective in the long term and could lead to increased distress. Gradual limits should be established over time to help the client manage and reduce the ritualistic behavior effectively.

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