Nursing Elites

1. What is the priority intervention for a patient admitted for an overdose of sedatives and diagnosed with dissociative identity disorder?

• A. Conducting a suicide assessment
• B. Arranging for placement in a group home
• C. Providing a low-stimulation environment
• D. Establishing trust and rapport

Correct answer: A

Rationale: Conducting a suicide assessment is the priority intervention for a patient admitted for an overdose of sedatives and diagnosed with dissociative identity disorder. In this scenario, the immediate concern is to assess the risk of harm to the patient's life. It is crucial to determine if the overdose was intentional and if the patient has suicidal ideation or intent. Arranging for placement in a group home (choice B) may be necessary at a later stage depending on the patient's needs, but it is not the priority in this urgent situation. Providing a low-stimulation environment (choice C) and establishing trust and rapport (choice D) are important aspects of care but addressing the immediate risk of suicide takes precedence in this case.

2. A healthcare professional is caring for a group of clients. Which of the following clients should the healthcare professional consider for referral to an assertive community treatment (ACT) group?

• A. A client in an acute care mental health facility who has fallen several times while running down the hallway
• B. A client who lives at home and keeps forgetting to come in for a scheduled monthly antipsychotic injection for schizophrenia
• C. A client in a day treatment program who reports increasing anxiety during group therapy
• D. A client in a weekly grief support group who reports still missing a deceased partner who has been dead for 3 months

Correct answer: B

Rationale: The client who lives at home and repeatedly forgets to come in for a scheduled monthly antipsychotic injection for schizophrenia should be considered for referral to an assertive community treatment (ACT) group. ACT teams provide intensive community-based treatment and support for individuals with severe mental illness who may have difficulty adhering to treatment on their own. Choices A, C, and D do not describe individuals with severe mental illness who have difficulty adhering to treatment or need intensive community-based support, which are the typical candidates for referral to an ACT group.

3. What is the most appropriate nursing diagnosis for a patient with agoraphobia who reports not having left their house in months?

• A. Social isolation
• B. Ineffective coping
• C. Risk for injury
• D. Impaired social interaction

Correct answer: A

Rationale: The nursing diagnosis 'Social isolation' is most appropriate for a patient with agoraphobia who has not left their house in months. Agoraphobia often leads to the avoidance of situations or places perceived as unsafe, resulting in social isolation. This diagnosis reflects the patient's limited social interactions and confinement to the home environment, which can impact their overall well-being and mental health. The other options are not as relevant in this scenario: 'Ineffective coping' does not directly address the social withdrawal aspect, 'Risk for injury' is not the primary concern presented, and 'Impaired social interaction' does not capture the extent of isolation described.

4. Gilbert, age 19, is described by his parents as a 'moody child' with an onset of odd behavior at age 14, which caused Gilbert to suffer academically and socially. Gilbert has lost the ability to complete household chores, is reluctant to leave the house, and is obsessed with the locks on the windows and doors. Due to Gilbert’s early and slow onset of what is now recognized as schizophrenia, his prognosis is considered:

• A. Favorable with medication
• B. In the relapse stage
• C. Improvable with psychosocial interventions
• D. To have a less positive outcome

Correct answer: D

Rationale: Individuals with an early and slow onset of schizophrenia typically have a less positive outcome or prognosis. This is because early onset schizophrenia is often associated with a more severe form of the illness and can lead to greater functional impairment in various aspects of life, including academic and social functioning. Therefore, the prognosis for Gilbert, given his presentation and age of onset, would be considered to have a less positive outcome.

5. When communicating with a client admitted for treatment of a substance use disorder, which of the following communication techniques should be identified as a barrier to therapeutic communication?

• A. Offering advice
• B. Reflecting
• C. Listening attentively
• D. Giving information

Correct answer: A

Rationale: Offering advice is a barrier to therapeutic communication because it can hinder the client's ability to explore their own solutions and feelings. It may come across as judgmental or dismissive of the client's experience, leading to a breakdown in trust and hindering the therapeutic relationship. Reflecting (choice B) is a helpful technique that involves paraphrasing or restating the client's words to show understanding. Listening attentively (choice C) is crucial for building rapport and demonstrating empathy. Giving information (choice D) is also important but should be done in a way that supports the client's understanding and autonomy, rather than directing their choices.

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