Nursing Elites

1. A patient with major depressive disorder is started on a tricyclic antidepressant (TCA). Which common side effect should the nurse educate the patient about?

• A. Hypertension
• B. Diarrhea
• C. Dry mouth
• D. Weight loss

Correct answer: C

Rationale: The correct answer is C: Dry mouth. Dry mouth is a common side effect associated with tricyclic antidepressants (TCAs). TCAs block acetylcholine receptors, leading to anticholinergic effects such as dry mouth, constipation, blurred vision, and urinary retention. It is important for the nurse to educate the patient about this side effect to promote awareness and provide appropriate management strategies, such as maintaining good oral hygiene and staying hydrated. Choice A, hypertension, is not a common side effect of TCAs. Choice B, diarrhea, is not a typical side effect of TCAs; in fact, TCAs are more likely to cause constipation. Choice D, weight loss, is less common with TCAs as they are more likely to cause weight gain.

2. A client diagnosed with OCD spends hours bathing and grooming. During a one-on-one interaction, the client discusses the rituals in detail but avoids any feelings that the rituals generate. Which defense mechanism should the nurse identify?

• A. Dissociation
• B. Rationalization
• C. Sublimation
• D. Intellectualization

Correct answer: D

Rationale: Intellectualization is a defense mechanism where an individual focuses on rational, logical explanations to distance themselves from uncomfortable emotions. In this scenario, the client discusses the OCD rituals in a detailed and analytical manner, avoiding the emotional aspects associated with them. This behavior reflects intellectualization rather than dissociation, rationalization, or sublimation. Dissociation involves a disconnection from reality, rationalization is the attempt to justify behaviors, and sublimation is redirecting unacceptable impulses into socially acceptable activities.

3. A healthcare provider is assessing a client who has been diagnosed with factitious disorder. Which of the following behaviors should the healthcare provider expect?

• A. Intentional production of false symptoms
• B. Lack of concern about symptoms
• C. Fear of gaining weight
• D. Unintentional production of false symptoms

Correct answer: A

Rationale: Individuals with factitious disorder deliberately fabricate or exaggerate symptoms to assume the sick role and garner attention. They may show a lack of concern about their symptoms, a phenomenon known as la belle indifférence. Fear of gaining weight is not typically associated with factitious disorder. Therefore, the correct behavior to expect in a client with factitious disorder is the intentional production of false symptoms. Choices B, C, and D are incorrect as lack of concern about symptoms and fear of gaining weight are not characteristic of factitious disorder. Additionally, factitious disorder involves the intentional, not unintentional, production of false symptoms.

4. In a patient with schizophrenia, which of the following symptoms would indicate a poor prognosis?

• A. Auditory hallucinations
• B. Paranoia
• C. Flat affect
• D. Delusions of grandeur

Correct answer: C

Rationale: A flat affect, characterized by a lack of emotional expression, is often linked to a poorer prognosis in schizophrenia. It can hinder social interactions and affect the individual's ability to engage in therapy or express emotions, thereby impacting the overall treatment outcomes. Auditory hallucinations (Choice A) and delusions of grandeur (Choice D) are common symptoms in schizophrenia but may not always indicate a poor prognosis. Paranoia (Choice B) can also vary in its impact on prognosis depending on the individual and the severity of the symptom.

5. What information should the nurse include in patient education for a patient prescribed valproic acid for bipolar disorder?

• A. Avoid consuming dairy products while taking this medication.
• B. Regular blood tests are necessary to monitor medication levels.
• C. Take the medication on an empty stomach for better absorption.
• D. It is safe to stop the medication abruptly if side effects occur.

Correct answer: B

Rationale: The correct answer is B: Regular blood tests are crucial when taking valproic acid to monitor the medication levels in the bloodstream. This monitoring helps ensure that the patient is receiving the correct dosage for effective treatment and to prevent adverse effects associated with either subtherapeutic or toxic levels of the medication. Choice A is incorrect because there is no specific interaction between valproic acid and dairy products. Choice C is incorrect as valproic acid can generally be taken with food to reduce gastrointestinal side effects. Choice D is incorrect as abruptly stopping valproic acid can lead to withdrawal symptoms and worsening of the condition.

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