Nursing Elites

1. Ted, a former executive, is now unemployed due to manic episodes at work. He was diagnosed with bipolar I 8 years ago. Ted has a history of IV drug abuse, which resulted in hepatitis C. He is taking his lithium exactly as scheduled, a fact that both Ted's wife and his blood tests confirm. To reduce Ted's mania, the psychiatric nurse practitioner recommends:

• A. Clonazepam (Klonopin)
• B. Fluoxetine (Prozac)
• C. Electroconvulsive therapy (ECT)
• D. Lurasidone (Latuda)

Correct answer: C

Rationale: Electroconvulsive therapy (ECT) can be an effective treatment for reducing mania in patients with bipolar disorder who have not responded to medication. In Ted's case, where he has a history of bipolar I disorder, lithium treatment, and manic episodes, ECT may be recommended by the psychiatric nurse practitioner to help manage his symptoms.

2. A client with schizophrenia is experiencing delusions. Which intervention should the nurse implement to address this symptom?

• A. Encourage the client to ignore the delusions.
• B. Provide reality-based feedback to the client.
• C. Distract the client from the delusions.
• D. Encourage the client to discuss the delusions.

Correct answer: B

Rationale: When a client with schizophrenia is experiencing delusions, providing reality-based feedback is considered an effective intervention to address this symptom. This approach helps the client differentiate between what is real and what is not real, assisting them in managing their delusions and promoting their overall well-being. Choice A is incorrect because ignoring the delusions does not help the client in distinguishing reality from delusions. Choice C is incorrect as distraction may only provide temporary relief but does not address the underlying issue. Choice D is incorrect because encouraging the client to discuss the delusions may reinforce or intensify them rather than help in managing them effectively.

3. A client diagnosed with OCD spends hours bathing and grooming. During a one-on-one interaction, the client discusses the rituals in detail but avoids any feelings that the rituals generate. Which defense mechanism should the nurse identify?

• A. Dissociation
• B. Rationalization
• C. Sublimation
• D. Intellectualization

Correct answer: D

Rationale: Intellectualization is a defense mechanism where an individual focuses on rational, logical explanations to distance themselves from uncomfortable emotions. In this scenario, the client discusses the OCD rituals in a detailed and analytical manner, avoiding the emotional aspects associated with them. This behavior reflects intellectualization rather than dissociation, rationalization, or sublimation. Dissociation involves a disconnection from reality, rationalization is the attempt to justify behaviors, and sublimation is redirecting unacceptable impulses into socially acceptable activities.

4. A client with generalized anxiety disorder (GAD) is being discharged. Which of the following instructions should the nurse not include in the discharge teaching?

• A. Practice relaxation techniques daily
• B. Avoid caffeine and alcohol
• C. Engage in regular physical activity
• D. Use benzodiazepines as the first-line treatment

Correct answer: D

Rationale: Discharge instructions for a client with GAD should include practicing relaxation techniques daily, avoiding caffeine and alcohol, engaging in regular physical activity, and seeking support from friends and family. Benzodiazepines are not recommended as the first-line treatment due to their potential for dependence and should not be included in the discharge teaching.

5. Which medication is commonly prescribed for the treatment of bipolar disorder?

• A. Sertraline
• B. Valproic acid
• C. Clozapine
• D. Haloperidol

Correct answer: B

Rationale: Valproic acid is commonly prescribed as a mood stabilizer for the treatment of bipolar disorder. It helps in controlling mood swings, preventing manic episodes, and reducing the risk of depressive episodes in individuals with bipolar disorder. Sertraline is an antidepressant typically used for major depressive disorder and other anxiety disorders, not for bipolar disorder. Clozapine and Haloperidol are antipsychotic medications primarily used in schizophrenia and other psychotic disorders, not as first-line treatments for bipolar disorder.

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