Nursing Elites

1. During cognitive-behavioral therapy, a 12-year-old patient reports to the nurse practitioner:

• A. I was so mad I wanted to hit my mother.
• B. I thought that everyone at school hated me. That's not true. Most people like me and I have a friend named Todd.
• C. I forgot that you told me to breathe when I become angry.
• D. I scream as loud as I can when the train goes by the house.

Correct answer: B

Rationale: In cognitive-behavioral therapy, recognizing and challenging negative thoughts is crucial for progress. Choice B demonstrates the patient's ability to identify and correct distorted thoughts, indicating positive advancement in therapy. This cognitive restructuring is a key component of cognitive-behavioral therapy, helping individuals develop healthier thinking patterns and coping strategies.

2. A client with major depressive disorder is prescribed an antidepressant. Which of the following instructions should the nurse include in the teaching? Select the one that does not apply.

• A. It may take several weeks for the medication to take effect
• B. Avoid alcohol while taking this medication
• C. Discontinue the medication abruptly
• D. You may experience an increase in energy before your mood improves

Correct answer: C

Rationale: Teaching for a client prescribed an antidepressant should include several key instructions. Firstly, it's important to inform the client that it may take several weeks for the medication to take effect, so they should be patient. Secondly, they should be advised to avoid alcohol while taking the medication as it can interact negatively with antidepressants. Additionally, abrupt discontinuation of antidepressants can lead to withdrawal symptoms and should be avoided. Lastly, clients may experience an increase in energy before their mood improves, which is a common effect of some antidepressants. Regular blood tests are not typically required for most antidepressants, but adherence to the prescribed regimen and reporting any concerning side effects to the healthcare provider are crucial.

3. A patient with schizophrenia is prescribed risperidone. The nurse should monitor the patient for which common side effect of this medication?

• A. Agranulocytosis
• B. Weight gain
• C. Hair loss
• D. Hyperthyroidism

Correct answer: B

Rationale: When a patient is prescribed risperidone, an atypical antipsychotic, the nurse should monitor for weight gain as it is a common side effect of this medication. Weight gain can occur due to metabolic changes and increased appetite associated with risperidone use. Agranulocytosis is a severe decrease in a type of white blood cells, and it is not a common side effect of risperidone. Hair loss and hyperthyroidism are also not typically associated with risperidone use.

4. When evaluating a client's progress in psychotherapy, which outcome is appropriate for the client?

• A. The client will identify triggers for anxiety.
• B. The client will develop coping strategies.
• C. The client will decrease avoidance behaviors.
• D. The client will express feelings of anger.

Correct answer: A

Rationale: In psychotherapy, identifying triggers for anxiety is a crucial step towards understanding and managing one's anxiety symptoms. By recognizing these triggers, clients can work on developing coping strategies and addressing the root cause of their anxiety, leading to improved mental health outcomes. Decreasing avoidance behaviors and expressing feelings of anger are also important aspects of therapy. However, identifying triggers for anxiety is a more specific and foundational goal in addressing anxiety disorders, making it the most appropriate outcome to evaluate a client's progress in psychotherapy.

5. What information should the nurse include in patient education for a patient prescribed valproic acid for bipolar disorder?

• A. Avoid consuming dairy products while taking this medication.
• B. Regular blood tests are necessary to monitor medication levels.
• C. Take the medication on an empty stomach for better absorption.
• D. It is safe to stop the medication abruptly if side effects occur.

Correct answer: B

Rationale: The correct answer is B: Regular blood tests are crucial when taking valproic acid to monitor the medication levels in the bloodstream. This monitoring helps ensure that the patient is receiving the correct dosage for effective treatment and to prevent adverse effects associated with either subtherapeutic or toxic levels of the medication. Choice A is incorrect because there is no specific interaction between valproic acid and dairy products. Choice C is incorrect as valproic acid can generally be taken with food to reduce gastrointestinal side effects. Choice D is incorrect as abruptly stopping valproic acid can lead to withdrawal symptoms and worsening of the condition.

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