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 patient with bipolar disorder is prescribed lithium. Which dietary advice should the nurse include?

• A. Avoid foods high in tyramine.
• B. Maintain a consistent salt intake.
• C. Increase protein intake.
• D. Avoid foods high in fat.

Correct answer: B

Rationale: Patients prescribed lithium should maintain a consistent salt intake. Fluctuations in salt intake can impact lithium levels, potentially leading to toxicity or reduced effectiveness of the medication. It is crucial for patients to adhere to a stable salt intake while taking lithium to ensure optimal treatment outcomes. Choices A, C, and D are incorrect. Avoiding foods high in tyramine is more relevant for patients on MAOIs, not lithium. Increasing protein intake or avoiding foods high in fat are not specific dietary recommendations for patients taking lithium.

3. How do psychiatrists determine which diagnosis to give a patient?

• A. Psychiatrists use pre-established criteria from the APA's Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
• B. Hospital policy dictates how psychiatrists diagnose mental disorders.
• C. Psychiatrists assess the patient and identify diagnoses based on the patient's symptoms and contributing factors.
• D. The American Medical Association identifies 10 diagnostic labels that psychiatrists can choose from.

Correct answer: A

Rationale: Psychiatrists use pre-established criteria from the APA's Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to determine which diagnosis to give a patient. The DSM-5 is a comprehensive manual published by the American Psychiatric Association (APA) that outlines specific criteria for diagnosing mental disorders. It aims to ensure accurate and consistent diagnosis and treatment. Choices B and D provide inaccurate information. Hospital policy does not dictate psychiatric diagnoses, and the American Medical Association does not provide diagnostic labels for mental disorders. Choice C, although mentioning the assessment of patients, does not highlight the specific criteria and guidelines provided by the DSM-5 that psychiatrists use to assign diagnoses.

4. In treating a patient with generalized anxiety disorder (GAD) using cognitive-behavioral therapy (CBT), what is the most appropriate goal of this therapy?

• A. To explore the patient's childhood experiences.
• B. To reduce the patient's symptoms through medication.
• C. To change the patient's negative thought patterns.
• D. To improve the patient's social skills.

Correct answer: C

Rationale: The most appropriate goal of cognitive-behavioral therapy (CBT) in treating generalized anxiety disorder (GAD) is to change the patient's negative thought patterns. This therapy focuses on identifying and modifying distorted thinking patterns that contribute to anxiety. Exploring childhood experiences (Choice A) may be part of therapy, but the primary focus is on present thoughts and behaviors. While medication (Choice B) can help manage symptoms, CBT aims to address the root cause through cognitive restructuring. Improving social skills (Choice D) is not the primary goal of CBT for GAD, although it may be a secondary benefit as confidence improves with reduced anxiety.

5. Which intervention should the nurse implement when caring for a patient demonstrating manic behavior? Select one that doesn't apply.

• A. Monitor the patient's vital signs frequently.
• B. Keep the patient distracted with group-oriented activities.
• C. Provide the patient with frequent milkshakes and protein drinks.
• D. Reduce the volume on the television and dim bright lights in the environment.

Correct answer: B

Rationale: When caring for a patient demonstrating manic behavior, it is crucial to monitor vital signs frequently to ensure the patient's physical health is stable. Providing nutrition, such as milkshakes and protein drinks, is essential to meet the patient's dietary needs. Diminishing environmental stimuli by reducing the volume on the television and dimming bright lights can help create a calmer environment. However, keeping the patient distracted with group-oriented activities may not be the most appropriate intervention as it could potentially exacerbate the manic behavior by overstimulating the patient. Therefore, this choice is the one that doesn't apply in managing manic behavior effectively.

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