Nursing Elites

1. When a patient with major depressive disorder is started on fluoxetine, what is the most important side effect for the nurse to monitor?

• A. Weight gain
• B. Suicidal ideation
• C. Hypertension
• D. Hyperglycemia

Correct answer: B

Rationale: When initiating fluoxetine therapy in a patient with major depressive disorder, monitoring for suicidal ideation is crucial due to the increased risk of suicidal thoughts or behaviors that can occur, especially in the initial phase of treatment. This close monitoring is essential to ensure patient safety and intervene promptly if such symptoms arise. Weight gain, hypertension, and hyperglycemia are potential side effects of some medications used to treat depression, but suicidal ideation is the most critical and immediate side effect to monitor for when starting fluoxetine.

2. A school nurse is assessing a female high school student who is overly concerned about her appearance. The client's mother states, 'That's not something to be stressed about!' Which is the most appropriate nursing response?

• A. Teenagers! They don't know a thing about real stress.
• B. Stress occurs only when there is a loss.
• C. When you are in poor physical condition, you can't experience psychological well-being.
• D. Stress can be psychological. A threat to self-esteem may result in high stress levels.

Correct answer: D

Rationale: The correct answer is D. Stress can manifest as physical or psychological. A perceived threat to self-esteem can be as stressful as a physiological change. Choice A is dismissive of the teenager's concerns and does not address the issue professionally. Choice B is incorrect as stress can result from various factors, not just loss. Choice C oversimplifies the relationship between physical condition and psychological well-being, neglecting the impact of mental stressors on overall health.

3. A client who experiences stress on a regular basis asks a nurse what causes these feelings. Which is the most appropriate nursing response?

• A. Genetics have no influence on your temperament.
• B. How you reacted to past experiences influences how you feel now.
• C. Maintaining good physical health always keeps stress levels low.
• D. Stress can be avoided by using appropriate coping mechanisms.

Correct answer: B

Rationale: The correct answer is B: 'How you reacted to past experiences influences how you feel now.' This response is appropriate because past experiences can shape an individual's current response to stress. It acknowledges the impact of learned patterns and coping mechanisms on one's current adaptation to stressors. Choice A is incorrect because genetics can play a role in temperament to some extent. Choice C is incorrect because while physical health can contribute to stress management, it is not the sole determinant of stress levels. Choice D is incorrect as stress is not always avoidable, but coping mechanisms can help manage and reduce its impact.

4. Which statement indicates an understanding of the DSM-5 diagnosis?

• A. The DSM-5 includes information on cultural considerations.
• B. The DSM-5 is a tool for healthcare providers.
• C. The DSM-5 is not used for legal purposes.
• D. The DSM-5 includes information on the prevalence of mental disorders.

Correct answer: A

Rationale: Option A is the correct answer as the DSM-5 not only provides specific criteria for diagnosing mental disorders but also includes information on cultural considerations. Understanding cultural factors is crucial in making accurate diagnoses and providing appropriate care, highlighting the comprehensive nature of the DSM-5 for healthcare providers. Choices B, C, and D are incorrect because while the DSM-5 is indeed a tool for healthcare providers, it is also used in legal settings, and it focuses on diagnostic criteria and not just the prevalence of mental disorders.

5. During the assessment of an adolescent who collapsed during Olympic figure skating training and was diagnosed with severe malnutrition due to anorexia nervosa, which client statement supports the use of a family-based approach?

• A. I eat just as much as everyone else on the team
• B. I'm tired of fighting with my parents about eating
• C. I just didn't drink enough water during practice
• D. I have to practice until my skating routine is perfect

Correct answer: B

Rationale: The statement 'I'm tired of fighting with my parents about eating' indicates a struggle related to food and parental conflicts, suggesting family dynamics play a role in the client's eating disorder. In cases of anorexia nervosa in adolescents, involving the family in the treatment process through a family-based approach has shown to be effective. This approach recognizes the influence of family interactions on the development and maintenance of eating disorders, aiming to improve communication, support, and understanding within the family unit to facilitate recovery.

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