Nursing Elites

1. Devastated by a divorce from an abusive husband, a wife completes grief counseling. Which statement by the wife should indicate to a nurse that the client is in the acceptance stage of grief?

• A. If only we could have tried again, things might have worked out.
• B. I am so mad that the children and I had to put up with him as long as we did.
• C. Yes, it was a difficult relationship, but I think I have learned from the experience.
• D. I still don't have any appetite and continue to lose weight.

Correct answer: C

Rationale: The nurse should recognize that the client is in the acceptance stage of grief based on the statement 'Yes, it was a difficult relationship, but I think I have learned from the experience.' In this statement, the client is acknowledging the difficulty of the relationship but also expressing personal growth and learning from the experience, indicating acceptance. Choices A, B, and D do not reflect the acceptance stage of grief. Choice A shows a sense of regret and a wish for things to have turned out differently. Choice B demonstrates lingering anger towards the ex-husband. Choice D suggests ongoing physical manifestations of grief like loss of appetite and weight loss, which are more indicative of earlier stages of grief.

2. In a client with obsessive-compulsive disorder (OCD) undergoing cognitive-behavioral therapy, which outcome indicates that the therapy is effective?

• A. The client reports a decrease in the frequency of compulsive behaviors.
• B. The client reports a decrease in the intensity of obsessive thoughts.
• C. The client reports an improvement in overall mood.
• D. The client reports an improvement in sleep patterns.

Correct answer: A

Rationale: In clients with OCD undergoing cognitive-behavioral therapy, a decrease in the frequency of compulsive behaviors is a key indicator of treatment effectiveness. This reduction signifies progress in managing and controlling the compulsions associated with OCD, which is a primary goal of the therapy. Choices B, C, and D may also be positive outcomes of therapy, but the most critical aspect in treating OCD with cognitive-behavioral therapy is targeting and reducing the frequency of compulsive behaviors.

3. A client has a history of excessive drinking, which has led to multiple arrests for driving under the influence (DUI). The client states, 'I work hard to provide for my family. I don't see why I can't drink to relax.' The nurse recognizes the use of which defense mechanism?

• A. Projection
• B. Rationalization
• C. Regression
• D. Sublimation

Correct answer: B

Rationale: The correct answer is Rationalization. The client is using rationalization as a defense mechanism by justifying their excessive drinking as a way to relax due to working hard to provide for their family. Rationalization involves creating logical excuses to justify unacceptable feelings or behaviors. Projection involves attributing one's unacceptable feelings or thoughts to others. Regression is reverting to an earlier stage of development in the face of unacceptable thoughts or impulses. Sublimation is the channeling of unacceptable impulses into socially acceptable activities.

4. A healthcare professional is assessing a client who is experiencing severe anxiety. Which of the following is an appropriate intervention?

• A. Encourage the client to talk about their feelings.
• B. Provide a quiet and calm environment.
• C. Encourage the client to exercise vigorously.
• D. Encourage the client to participate in group activities.

Correct answer: B

Rationale: During severe anxiety, it is essential to create a quiet and calm environment to help the client feel safe and reduce anxiety levels. Loud or stimulating environments can exacerbate anxiety symptoms, so providing a serene setting can promote relaxation and a sense of security.

5. A distraught, single, first-time mother cries and asks a nurse, 'How can I go to work if I can't afford childcare?' What is the nurse's initial action in assisting the client with the problem-solving process?

• A. Determine the risks and benefits for each alternative.
• B. Formulate goals for resolution of the problem.
• C. Evaluate the outcome of the implemented alternative.
• D. Assess the facts of the situation.

Correct answer: D

Rationale: In this scenario, the nurse's initial step should be to assess the facts of the situation. By gathering accurate information about the client's circumstances, the nurse can better understand the problem and make informed decisions moving forward. This foundational assessment is crucial before proceeding to formulate goals, evaluate outcomes, or consider risks and benefits. Options A, B, and C involve steps that should follow the initial assessment of the situation, making them less suitable as the initial action in this context.

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