Nursing Elites

1. When an individual's stress response is sustained over a long period of time, which physiological effect of the endocrine system should one anticipate?

• A. Decreased resistance to disease
• B. Increased libido
• C. Decreased blood pressure
• D. Increased inflammatory response

Correct answer: A

Rationale: When stress is prolonged, the body reaches the stage of exhaustion in the general adaptation syndrome, where compensatory mechanisms fail, and diseases of adaptation may occur. One physiological effect includes a decreased immune response, leading to decreased resistance to disease. Therefore, the correct answer is A. Increased libido (choice B) is not a typical physiological effect related to prolonged stress. Decreased blood pressure (choice C) is not commonly associated with sustained stress. Increased inflammatory response (choice D) may occur in the short term due to stress, but over a prolonged period, the immune system's function weakens, leading to decreased resistance to disease.

2. A client diagnosed with major depressive disorder is receiving cognitive-behavioral therapy (CBT). Which outcome indicates that the therapy is effective?

• A. The client identifies and challenges negative thoughts.
• B. The client reports an increase in suicidal thoughts.
• C. The client experiences an increase in anxiety.
• D. The client shows no change in behavior.

Correct answer: A

Rationale: In cognitive-behavioral therapy (CBT), one of the primary objectives is to help clients identify and challenge their negative thoughts. This process allows the individual to reframe their thinking patterns and develop more adaptive coping strategies. Reporting an increase in suicidal thoughts (Choice B) or experiencing an increase in anxiety (Choice C) are not desired outcomes and may indicate a need for further intervention. Showing no change in behavior (Choice D) suggests that the therapy has not been effective. Therefore, the correct indicator of effective therapy in this context is the client's ability to identify and challenge negative thoughts (Choice A).

3. A client has been prescribed sertraline for depression, and the nurse is providing discharge instructions. Which dietary instruction should the nurse include?

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

Correct answer: C

Rationale: Clients prescribed sertraline should avoid foods high in tyramine to prevent a hypertensive crisis. Sertraline, an antidepressant belonging to the selective serotonin reuptake inhibitor (SSRI) class, can interact with tyramine-rich foods, potentially causing a dangerous increase in blood pressure known as a hypertensive crisis. Choices A, B, and D are incorrect because there is no specific dietary restriction related to sodium, calcium, or potassium intake when taking sertraline.

4. Which intervention would be appropriate for assisting a client diagnosed with major depressive disorder?

• A. Encourage discussion of feelings
• B. Offer family therapy sessions
• C. Discuss childhood events
• D. Teach alternate coping skills

Correct answer: B

Rationale: Offering family therapy sessions would be the most appropriate intervention for a client diagnosed with major depressive disorder. Family therapy can be beneficial as it addresses interpersonal relationships within the family system, which is crucial in managing major depressive disorder effectively. This approach aligns with Sullivan's interpersonal theory, which emphasizes the impact of interpersonal relationships on individual behavior and personality development. In contrast, encouraging discussion of feelings, discussing childhood events, or teaching alternate coping skills may not directly address the interpersonal dynamics contributing to the client's major depressive disorder.

5. When assessing a patient with generalized anxiety disorder (GAD), which symptom would the nurse most likely observe?

• A. Flashbacks
• B. Excessive worry
• C. Hallucinations
• D. Compulsive behaviors

Correct answer: B

Rationale: Excessive worry is a characteristic feature of generalized anxiety disorder (GAD). Patients with GAD experience persistent and excessive worry about various aspects of their life, such as work, health, or family, even when there is little or no reason for concern. This chronic worrying can significantly impact their daily functioning and quality of life. Flashbacks are more commonly associated with post-traumatic stress disorder (PTSD), hallucinations are more typical in conditions like schizophrenia, while compulsive behaviors are seen in obsessive-compulsive disorder (OCD). Therefore, in the context of GAD, excessive worry is the symptom that the nurse is most likely to observe.

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