Nursing Elites

1. A patient with social anxiety disorder is starting cognitive-behavioral therapy (CBT). Which statement by the nurse best explains the purpose of this therapy?

• A. CBT will help you understand and change your thought patterns.
• B. CBT will focus on exploring your childhood experiences.
• C. CBT will teach you relaxation techniques to use in social situations.
• D. CBT will help you avoid situations that cause anxiety.

Correct answer: A

Rationale: Cognitive-behavioral therapy (CBT) is a structured, short-term psychotherapy that aims to help patients identify and change negative thought patterns and behaviors associated with anxiety. By understanding and altering these patterns, individuals can learn to manage and alleviate their symptoms effectively. Choice A is the correct answer as it accurately describes the purpose of CBT for social anxiety disorder. Choices B, C, and D are incorrect. B is incorrect because while childhood experiences may be explored, the primary focus of CBT is on thought patterns and behaviors in the present. C is incorrect because although relaxation techniques may be a component of CBT, the primary goal is not just to teach relaxation but to address underlying cognitive and behavioral patterns. D is incorrect because the goal of CBT is not avoidance but rather to confront and manage anxiety-provoking situations.

2. 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.

3. What assessment findings would indicate lithium toxicity in a patient hospitalized for an acute manic episode?

• A. Shortness of breath, gastrointestinal distress, chronic cough
• B. Ataxia, severe hypotension, large volume of dilute urine
• C. Gastrointestinal distress, thirst, nystagmus
• D. Electroencephalographic changes, chest pain, dizziness

Correct answer: B

Rationale: In a patient suspected of lithium toxicity, the presence of ataxia, severe hypotension, and a large volume of dilute urine are key assessment findings. Ataxia is a sign of central nervous system involvement, severe hypotension indicates cardiovascular effects, and a large volume of dilute urine suggests renal impairment, all of which are commonly seen in severe lithium toxicity. Options A, C, and D do not align with typical signs of lithium toxicity.

4. What principle about patient 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 talking to you than listening to what you have to say, so they are not likely to be offended.
• C. Considering the patient's history, there is little chance that the comment will do any actual harm.
• D. Most people with a mental illness have, by necessity, developed a high tolerance for forgiveness.

Correct answer: A

Rationale: Effective patient communication is guided by the principle that patients value genuine acceptance, respect, and concern from their caregivers. This approach helps to build trust and fosters effective communication, enhancing the nurse-patient relationship. Choice B is incorrect because patients value both talking and listening in effective communication. Choice C is incorrect because a nurse should always consider the impact of their words on the patient, regardless of the patient's history. Choice D is incorrect as it generalizes about people with mental illness and forgiveness, which is not directly relevant to patient communication.

5. Which patient behavior is consistent with therapeutic communication?

• A. Offering your opinion when asked to provide support.
• B. Summarizing the essence of the patient’s comments in your own words.
• C. Avoiding interrupting periods of silence to allow the patient space to think.
• D. Providing positive reinforcement when the patient expresses themselves.

Correct answer: B

Rationale: Summarizing the essence of the patient’s comments in your own words is a key component of therapeutic communication. This behavior demonstrates active listening, ensures understanding of the patient's message, and encourages further discussion. By summarizing, you show the patient that you are engaged and interested, which helps them feel heard and valued. Offering your opinion (choice A) may bias the patient's thoughts and feelings, interrupting periods of silence (choice C) may prevent the patient from processing their thoughts, and providing positive reinforcement (choice D) may not always be appropriate or necessary in therapeutic communication.

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