Nursing Elites

1. In planning care for the termination phase of a nurse-client relationship, which of the following actions should the nurse include in the plan of care?

• A. Discussing ways to use new behaviors
• B. Practicing new problem-solving skills
• C. Developing goals
• D. Establishing boundaries

Correct answer: A

Rationale: During the termination phase of a nurse-client relationship, it is crucial to discuss ways to use new behaviors. This helps the client integrate and apply the skills and strategies they have acquired during the therapeutic process into their daily life. By focusing on the application of new behaviors, the client can maintain progress and continue to grow even after the professional relationship has ended. Practicing new problem-solving skills, developing goals, and establishing boundaries are important aspects of the therapeutic process but are more commonly addressed in earlier phases of the nurse-client relationship. Therefore, the correct action to include in the plan of care during the termination phase is discussing ways to use new behaviors.

2. A client tells a nurse, 'Don’t tell anyone, but I hid a sharp knife under my mattress to protect myself from my threatening roommate.' Which of the following actions should the nurse take?

• A. Keep the client’s communication confidential, but talk to the client daily using therapeutic communication to convince them to admit to hiding the knife
• B. Keep the client’s communication confidential, but watch the client and their roommate closely
• C. Tell the client that this must be reported to the health care team because it concerns the health and safety of the client and others
• D. Report the incident to the health care team but do not inform the client of the intention to do so

Correct answer: C

Rationale: In this scenario, the nurse must prioritize the safety of the client and others. The client's disclosure of hiding a sharp knife under the mattress poses a significant risk. It is crucial for the nurse to inform the health care team about this situation to ensure immediate intervention and prevent any harm. Confidentiality is important in nursing care, but in cases where there is a clear threat to safety, the duty to protect overrides the duty of confidentiality. Reporting the incident to the health care team is essential to address the safety concerns and provide appropriate support and intervention for the client. Choices A and B are incorrect because while confidentiality is important, the immediate safety concern outweighs keeping the client's communication confidential or simply monitoring the situation. Choice D is incorrect as it does not involve informing the client, which can impact the therapeutic relationship and trust between the nurse and the client.

3. A client has a new prescription for disulfiram for the treatment of alcohol use disorder. The nurse informs the client that this medication can cause nausea and vomiting when alcohol is consumed. Which of the following types of treatment is this method an example of?

• A. Aversion therapy
• B. Flooding
• C. Biofeedback
• D. Dialectical behavior therapy

Correct answer: A

Rationale: Aversion therapy is a form of behavioral therapy that aims to create a negative response to a stimulus, in this case, alcohol consumption. Disulfiram is used in aversion therapy to induce unpleasant effects when alcohol is consumed, such as nausea and vomiting, to deter the individual from drinking. Therefore, the use of disulfiram in this context exemplifies aversion therapy. Flooding involves exposing an individual to a feared object or situation to overcome anxiety; biofeedback teaches self-regulation techniques, and dialectical behavior therapy is a type of cognitive-behavioral therapy focusing on acceptance and change strategies, which are not directly related to the use of disulfiram for alcohol use disorder.

4. Which individual is likely experiencing symptoms of derealization?

• A. I just feel like I’m looking at life through a fog and that can’t be my face in the mirror.
• B. I cannot recall why I’m living in this town or how I got here.
• C. There are just too many people living in my head now.
• D. I feel like I’m going to die, I’m having a heart attack.

Correct answer: A

Rationale: The individual describing feeling like they are looking at life through a fog and questioning their reflection in the mirror is likely experiencing symptoms of derealization. Derealization involves feelings of detachment from one's surroundings, which can manifest as a sense of unreality or distortion of the environment. Choice B describes dissociative amnesia, which involves memory loss related to personal information or traumatic events. Choice C suggests dissociative identity disorder (DID), where a person experiences two or more distinct identities or personality states. Choice D indicates symptoms of a panic attack, such as fearing imminent death and physical sensations like a heart attack.

5. Which therapeutic approach is most effective for a patient with generalized anxiety disorder (GAD)?

• A. Psychoanalytic therapy
• B. Cognitive-behavioral therapy (CBT)
• C. Humanistic therapy
• D. Gestalt therapy

Correct answer: B

Rationale: Cognitive-behavioral therapy (CBT) is the most effective therapeutic approach for generalized anxiety disorder (GAD). CBT helps individuals identify and modify negative thought patterns and behaviors that contribute to anxiety. It focuses on changing cognitive distortions and maladaptive behaviors, providing practical strategies to manage anxiety symptoms effectively. Numerous studies have shown the effectiveness of CBT in treating GAD by helping patients develop coping mechanisms and skills to address their anxiety. Choice A, Psychoanalytic therapy, is not the most effective for GAD as it primarily focuses on exploring unconscious conflicts and childhood experiences rather than providing immediate coping strategies. Choice C, Humanistic therapy, emphasizes personal growth and self-improvement, which may not directly target the specific symptoms of GAD. Choice D, Gestalt therapy, focuses on increasing self-awareness and personal responsibility, which might not address the cognitive distortions and behavioral patterns associated with GAD as directly as CBT does.

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