Nursing Elites

1. During a treatment team meeting, the point is made that a client with schizophrenia has recovered from the acute psychosis but continues to demonstrate apathy, avolition, and blunted affect. The nurse who relates these symptoms to serotonin excess will suggest that the client receive?

• A. Chlorpromazine
• B. Phenelzine
• C. Haloperidol
• D. Olanzapine

Correct answer: D

Rationale: In this scenario, the symptoms of apathy, avolition, and blunted affect are indicative of negative symptoms commonly seen in schizophrenia. These symptoms are often associated with dopamine and serotonin imbalances in the brain. Olanzapine, an atypical antipsychotic, is known for its efficacy in treating both positive and negative symptoms of schizophrenia. It acts by blocking serotonin and dopamine receptors, helping to alleviate the symptoms mentioned. Chlorpromazine and Haloperidol are typical antipsychotics that primarily target dopamine receptors, while Phenelzine is an MAOI used to treat depression and anxiety disorders, not schizophrenia. Therefore, the most appropriate choice for this client displaying these symptoms related to serotonin excess would be Olanzapine.

2. Substance abuse is often present in individuals diagnosed with bipolar disorder. Laura, a 28-year-old with a bipolar disorder diagnosis, chooses to drink alcohol instead of taking her prescribed medications. The nurse caring for this patient recognizes that:

• A. Anxiety may be present.
• B. Alcohol ingestion is a form of self-medication.
• C. The patient is lacking a sufficient number of neurotransmitters.
• D. The patient is using alcohol as a coping mechanism.

Correct answer: B

Rationale: Individuals with bipolar disorder may turn to alcohol as a form of self-medication to cope with their symptoms. This behavior is often seen as an attempt to manage mood swings and alleviate distress. It is important for healthcare providers to address and manage substance abuse issues in patients with bipolar disorder to ensure proper treatment and overall well-being.

3. A client diagnosed with borderline personality disorder tells the nurse, 'You are the only one who understands me. The other nurses don't care about me.' Which of the following responses should the nurse make?

• A. Why do you feel that way?
• B. The other nurses care about you too.
• C. You shouldn't say things like that.
• D. I think you are overreacting.

Correct answer: B

Rationale: The correct response is to acknowledge the client's feelings and provide support while also emphasizing that all staff members care about the client's well-being. Choice A does not acknowledge the client's emotions and may come across as dismissive. Choice C invalidates the client's feelings and may make the client feel misunderstood. Choice D minimizes the client's emotions, which can lead to a breakdown in therapeutic communication. Therefore, option B is the most appropriate response as it validates the client's feelings while reinforcing the idea that the entire healthcare team is supportive.

4. A client has been prescribed a monoamine oxidase inhibitor (MAOI). Which dietary restriction should the nurse emphasize during discharge instructions?

• A. Avoid foods high in potassium.
• B. Avoid foods high in calcium.
• C. Avoid foods high in tyramine.
• D. Avoid foods high in sodium.

Correct answer: C

Rationale: The correct answer is C: Avoid foods high in tyramine. Clients taking MAOIs should avoid foods high in tyramine to prevent hypertensive crisis. Tyramine is found in aged, fermented, or spoiled foods. Choices A, B, and D are incorrect because potassium, calcium, and sodium restrictions are not specifically required for clients taking MAOIs.

5. When under stress, a client routinely uses an excessive amount of alcohol. Finding her drunk, her husband yells at her about the chronic alcohol abuse. Which reaction should the nurse recognize as the use of the defense mechanism of denial?

• A. Hiding liquor bottles in a closet
• B. Yelling at their son for slouching in his chair
• C. Burning dinner on purpose
• D. Saying to the spouse, 'I don't drink too much!'

Correct answer: D

Rationale: The nurse should recognize the client's statement 'I don't drink too much!' as the use of the defense mechanism of denial. This response indicates the client's refusal to acknowledge the reality of excessive alcohol consumption, which is a key characteristic of denial. By denying the problem, the client avoids facing the negative consequences and feelings associated with their alcohol abuse. Choices A, B, and C do not exhibit denial but rather represent different defense mechanisms. Hiding liquor bottles in a closet might indicate the defense mechanism of concealment, yelling at their son for slouching in his chair could reflect displacement, and burning dinner on purpose might suggest passive-aggressive behavior.

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