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. A client who is at risk for suicide following their partner’s death is speaking with a nurse. Which of the following statements should the nurse make?

• A. “I feel very sorry for the loneliness you must be experiencing.”
• B. “Suicide is not the appropriate way to cope with loss.”
• C. “Losing someone close to you must be very upsetting.”
• D. “I know how difficult it is to lose a loved one.”

Correct answer: C

Rationale: When a client is at risk for suicide, it is crucial for the nurse to acknowledge the emotional impact of losing a loved one without downplaying or judging their feelings. Statement C demonstrates empathy and understanding without making assumptions or providing unsolicited advice, making it the most appropriate response in this situation. Choice A focuses more on the nurse's feelings rather than the client's, which might not effectively address the client's emotional state. Choice B is judgmental and dismissive, which could further isolate the client. Choice D, although empathetic, shifts the focus to the nurse's experience rather than validating the client's feelings.

3. Child protective services have removed 10-year-old Christopher from his parents’ home due to neglect. Christopher reveals to the nurse that he considers the woman next door his “nice” mom, that he loves school, and gets above-average grades. The strongest explanation for this response is:

• A. Temperament
• B. Genetic factors
• C. Resilience
• D. Paradoxical effects of neglect

Correct answer: C

Rationale: Resilience is the ability to adapt well despite adversity, which is demonstrated by Christopher's positive relationships and school performance. Despite the challenging situation of being removed from his parents' home, Christopher's ability to form a positive bond with the neighbor, enjoy school, and excel academically showcases his resilience in coping with the circumstances.

4. Carolina is surprised when her patient does not show for a regularly scheduled appointment. When contacted, the patient states, “I don’t need to come see you anymore. I have found a therapy app on my phone that I love.” How should Carolina respond to this news?

• A. That sounds exciting; would you be willing to visit and show me the app?
• B. At this time, there is no real evidence that the app can replace our therapy.
• C. I am not sure that is a good idea right now; we are so close to progress.
• D. Why would you think that is a better option than meeting with me?

Correct answer: A

Rationale: Carolina should respond by showing interest in the app, as it can help maintain the therapeutic relationship and provide an opportunity to evaluate the app's effectiveness together. By asking the patient to visit and show the app, Carolina demonstrates openness to exploring new tools that the patient finds helpful, while also ensuring that the patient's well-being remains a priority. This approach fosters communication, allows for a collaborative discussion on how the app fits into the patient's treatment plan, and may potentially address any concerns or misconceptions the patient has about the app replacing traditional therapy.

5. April, a 10-year-old admitted to inpatient pediatric care, has been becoming increasingly agitated and losing control in the day room. Time-out has proven to be ineffective for April to engage in self-reflection. April’s mother mentions using time-out up to 20 times a day. The nurse acknowledges that:

• A. Time-out is a crucial aspect of April’s baseline discipline.
• B. Time-out is no longer an effective intervention.
• C. April finds enjoyment in time-out and misbehaves to seek solitude.
• D. Time-out will have to be replaced with seclusion and restraint.

Correct answer: B

Rationale: The scenario describes how April's behavior is not improving with the frequent use of time-out, indicating that it is no longer an effective intervention. When a strategy such as time-out loses its effectiveness due to overuse, it is crucial to explore alternative therapeutic measures to address the underlying issues effectively.

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