Nursing Elites

1. For a patient with obsessive-compulsive disorder (OCD) who spends several hours a day washing her hands, which type of therapy is most appropriate?

• A. Exposure and response prevention
• B. Dialectical behavior therapy
• C. Family therapy
• D. Interpersonal therapy

Correct answer: A

Rationale: Exposure and response prevention (ERP) is the most appropriate therapy for managing OCD. ERP involves exposing the patient to anxiety-provoking stimuli (such as touching dirty objects) and preventing the compulsive response (hand washing), thus helping the patient learn to tolerate the anxiety without performing the ritualistic behavior. Dialectical behavior therapy (DBT) focuses more on emotional regulation and interpersonal skills, making it less suitable for directly addressing OCD symptoms. Family therapy and interpersonal therapy may be beneficial for other conditions or relationship issues but are not specifically designed to target OCD symptoms like ERP.

2. Which mood stabilizer is commonly prescribed for bipolar disorder?

• A. Sertraline
• B. Lithium
• C. Clozapine
• D. Haloperidol

Correct answer: B

Rationale: Lithium is a well-established mood stabilizer commonly prescribed for the treatment of bipolar disorder. It helps to control manic episodes, stabilize mood swings, and reduce the risk of relapse in individuals with this condition. Sertraline is an antidepressant commonly used for treating depression, while Clozapine and Haloperidol are antipsychotic medications used for different psychiatric conditions. Therefore, the correct answer is B because it is specifically indicated and effective for bipolar disorder.

3. What principle about patient-nurse communication should guide a nurse's fear of saying the wrong thing to a patient?

• A. Patients tend to appreciate a well-meaning person who conveys genuine acceptance, respect, and concern for their situation.
• B. Patients are more interested in conversing with you than in hearing your perspective, making offense unlikely.
• C. Considering the patient's background, the likelihood of the comment causing harm is minimal.
• D. Individuals with mental illness often possess a heightened capacity for forgiveness.

Correct answer: A

Rationale: The correct answer is A. Patients value interactions with healthcare providers who express genuine acceptance, respect, and concern for their well-being. By focusing on conveying these qualities, a nurse can help alleviate fears of saying the wrong thing as patients appreciate the sincerity and empathy in the communication. This approach fosters trust and a positive therapeutic relationship, enhancing the effectiveness of patient-nurse communication.

4. A nurse is assessing a client with suspected post-traumatic stress disorder (PTSD). Which of the following findings shouldn't the nurse expect?

• A. Flashbacks
• B. Avoidance of reminders of the trauma
• C. Increased arousal and hypervigilance
• D. Manic episodes

Correct answer: D

Rationale: Findings in a client with PTSD include flashbacks, avoidance of reminders of the trauma, increased arousal and hypervigilance, and negative changes in thoughts and mood. Manic episodes are not typically associated with PTSD.

5. A patient with major depressive disorder is started on venlafaxine. Which class of antidepressant does this medication belong to?

• A. Selective serotonin reuptake inhibitors (SSRIs)
• B. Tricyclic antidepressants (TCAs)
• C. Monoamine oxidase inhibitors (MAOIs)
• D. Serotonin-norepinephrine reuptake inhibitors (SNRIs)

Correct answer: D

Rationale: Venlafaxine is classified as a serotonin-norepinephrine reuptake inhibitor (SNRI). SNRIs work by increasing the levels of both serotonin and norepinephrine in the brain, which helps alleviate symptoms of depression. This mechanism of action distinguishes SNRIs from other classes of antidepressants like SSRIs, TCAs, and MAOIs, making venlafaxine an effective choice for patients with major depressive disorder. Therefore, the correct answer is D. Choice A, SSRIs, primarily target serotonin reuptake only. Choice B, TCAs, work by inhibiting the reuptake of norepinephrine and serotonin, but they are not as selective as SNRIs. Choice C, MAOIs, inhibit the enzyme monoamine oxidase, leading to increased levels of various neurotransmitters, including serotonin and norepinephrine, but they are typically used as second- or third-line agents due to dietary restrictions and potential side effects.

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