Nursing Elites

1. According to psychodynamic theory, what purpose do delusions serve?

• A. Delusions are a defense against anxiety caused by real or imagined threats.
• B. Magical thinking is a delusion that ensures desirable outcomes.
• C. Delusions are a method of dealing with and interpreting external stimuli.
• D. Subconsciously, delusions are a way to safely express anger and hostility.

Correct answer: A

Rationale: According to psychodynamic theory, delusions serve as a defense mechanism against anxiety triggered by real or perceived threats. Delusions are the individual's unconscious way of protecting themselves from overwhelming feelings of anxiety. Magical thinking, on the other hand, involves believing that one's thoughts can influence external events. This is not the same as delusions. Delusions are not a way of interpreting external stimuli but rather a defense mechanism. Expressing anger and hostility is typically associated with defense mechanisms like displacement or projection, not delusions.

2. Which of the following is an example of an opioid?

• A. Mescaline
• B. Diazepam
• C. Phenobarbital
• D. Methadone

Correct answer: D

Rationale: Opioids are a type of drug classified as narcotics. Nurses working with clients with substance abuse issues often encounter opioids. Opioids have the potential for addiction. Examples of opioids include methadone, codeine, morphine, and hydromorphone. Mescaline (Choice A) is a hallucinogen, not an opioid. Diazepam (Choice B) is a benzodiazepine used to treat anxiety and other conditions, not an opioid. Phenobarbital (Choice C) is a barbiturate used to treat seizures and insomnia, not an opioid.

3. A client who has been on hemodialysis for 2 years communicates in an angry, critical manner and does not adhere to the prescribed medications and diet. Which explanation for the client's behavior would be useful to consider in planning care?

• A. An attempt to punish the nursing staff
• B. A constructive method of accepting reality
• C. A defense against underlying depression and fear
• D. An effort to maintain life and to live it as fully as possible

Correct answer: C

Rationale: The client's angry, critical communication and non-adherence to treatment suggest underlying emotional struggles. The behavior is likely a defense mechanism against feelings of depression and fear. It is essential to consider that the client's actions are not intentionally aimed at punishing others but rather a manifestation of internal distress. Option A is incorrect as the behavior is not about punishing the nursing staff. Option B is incorrect because the behavior is not a constructive way of accepting reality but rather a maladaptive coping mechanism. Option D is incorrect as the behavior is not primarily driven by an effort to maintain life but rather by emotional distress.

4. A client is receiving treatment for delusional behavior. He believes that his neighbor is purposefully poisoning his water system in an attempt to make him sick. Which of the following responses of the nurse is most appropriate?

• A. Did you have the water tested to be sure?
• B. Why do you feel like your neighbor is trying to poison you?
• C. Let's just sit here and watch this television program.
• D. Don't be silly; your neighbor would do no such thing.

Correct answer: B

Rationale: When a client presents with delusional beliefs, the nurse should avoid arguing with the client and should accept the client's initial need to hold onto the delusions. By asking the client 'Why do you feel like your neighbor is trying to poison you?' the nurse encourages the client to express his beliefs further. This open-ended question allows the client to elaborate on his delusions without feeling judged. It helps build trust between the nurse and the client, which is crucial for therapeutic communication. This approach may eventually lead to the client being more receptive to exploring and addressing his delusions. Choices A, C, and D are incorrect. Choice A may come off as dismissive and does not address the client's underlying beliefs. Choice C is a distraction and does not address the client's concerns. Choice D is confrontational and dismissive of the client's beliefs, which can damage the therapeutic relationship.

5. What is the similarity between the stage-crisis theory proposed by Havighurst and the psychosocial development theory formulated by Erikson?

• A. Based on developmental tasks
• B. Incorporate eight stages of development
• C. Based on changes in a person's thoughts and emotions
• D. Emphasize that a child's growth is directed by individual gene activity

Correct answer: A

Rationale: Both Havighurst's stage-crisis theory and Erikson's psychosocial development theory are grounded in the concept of developmental tasks. They both emphasize that successful completion of specific tasks at various life stages is crucial for healthy development. While Erikson's theory consists of eight stages of psychosocial development, Havighurst's theory comprises six stages. The idea that a child's growth is guided by individual gene activity is attributed to Gesell's theory, not Havighurst or Erikson. The emphasis on changes in a person's thoughts, emotions, and behaviors shaping beliefs about morality aligns with moral development theory, not specifically with Havighurst's or Erikson's theories.

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