Nursing Elites

1. Which of the following is an advantage of working with psychiatric clients in a group setting?

• A. Clients assist each other through therapeutic interventions with the support of a nurse
• B. Clients can receive peer support and feedback in a safe and controlled environment
• C. Clients can share experiences and coping strategies while maintaining confidentiality
• D. Clients learn from others when their behaviors are inappropriate in a safe and trusting environment

Correct answer: D

Rationale: Group therapy is a valuable approach in mental health treatment. Working with psychiatric clients in a group setting offers various benefits. Clients in a group setting can learn from others when their behaviors are inappropriate in a safe and trusting environment. This environment allows individuals to express thoughts and feelings without fear of judgment or criticism, fostering a supportive atmosphere. Through interactions with peers, clients can gain insight into their own behaviors and learn alternative ways of coping. Choice A is incorrect as the presence and support of a nurse are typically important in group therapy sessions. Choice B is incorrect as group settings provide structure and rules to ensure a safe space for clients to express themselves. Choice C is incorrect as maintaining confidentiality is crucial in group therapy to build trust and encourage open sharing.

2. A client who has undergone a mastectomy because of breast cancer is now undergoing chemotherapy, which has caused hair loss. The client states, 'I feel like I've lost my sense of power.' Which response would the nurse give?

• A. 'Hair does not empower a person.'
• B. 'Losing power seems important to you.'
• C. Knowledge is power; I'll give you some pamphlets to read.'
• D. 'Hair loss is common; it will grow back, so you should not worry.'

Correct answer: B

Rationale: The correct response is, 'Losing power seems important to you.' This response acknowledges the client's feelings and provides an opportunity for further discussion. Choice A is confrontational and dismissive, potentially shutting down communication. Choice C offers pamphlets, which may be seen as dismissing the client's concerns and avoiding engaging in a conversation. Choice D minimizes the client's feelings and may discourage further expression of emotions. By choosing option B, the nurse shows empathy and encourages the client to explore their emotions in a supportive environment.

3. An adolescent reports irregularity in menses. Her mother complains that her child often fears gaining weight, has poor caloric intake, and has a distorted self-image. Which could be the reason for irregular menses?

• A. Bulimia
• B. Anorexia
• C. Orthorexia
• D. Binge eating disorder

Correct answer: B

Rationale: The correct answer is 'Anorexia.' Anorexia is characterized by a lack of caloric intake motivated by a strong fear of gaining weight, leading to poor nutrition and potential irregular menses. Bulimia involves binge eating followed by compensatory behaviors. Orthorexia is characterized by an obsession with eating only healthy or 'pure' foods. Binge eating disorder is characterized by consuming large amounts of high-calorie food in a short period.

4. A client was admitted to the psychiatric unit after complaining to her friends and family that neighbors have bugged her home in order to hear all of her business. She remains aloof from other clients, paces the floor and believes that the hospital is a house of torture. Nursing interventions for the client should appropriately focus on efforts to

• A. Convince the client that the hospital staff is trying to help
• B. Help the client to enter into group recreational activities
• C. Provide interactions to help the client learn to trust staff
• D. Arrange the environment to limit the client's contact with other clients

Correct answer: C

Rationale: The correct nursing intervention for the client in this scenario is to provide interactions to help the client learn to trust staff. This approach focuses on building trust and establishing a therapeutic alliance between the client and the healthcare team. Choice A is incorrect because simply convincing the client that the hospital staff is trying to help may not address the underlying issue of trust. Choice B is not the priority at this stage as the client is exhibiting symptoms of paranoia and discomfort. Choice D may further isolate the client and hinder the therapeutic relationship. Therefore, the most appropriate intervention is to engage in interactions that promote trust and a therapeutic connection between the client and the staff.

5. Jerry is a 55-year-old veteran who has been admitted after a motor vehicle accident with multiple injuries. His friend reported that he had been using synthetic marijuana prior to the accident, and that he also sees a psychiatrist at the VA hospital for an unknown diagnosis. He stated that Jerry sometimes gets "hyper"? for no reason, starts "ranting"? and becomes violent. Of the following, which general psychiatric disorder is characterized by a pattern of aggression or violence that includes irritability, agitation, and violent behavior during manic or psychotic episodes?

• A. Schizophrenia
• B. Post-traumatic stress disorder (PTSD)
• C. Bipolar disorder
• D. Delusional disorder

Correct answer: C

Rationale: Bipolar disorder is characterized by a pattern of aggression or violence that includes irritability, agitation, and violent behavior during manic or psychotic episodes. This disorder is highly co-morbid with substance use, which can worsen the prognosis. While schizophrenia may involve aggression, it is not typically associated with mood episodes like mania that characterize bipolar disorder. Post-traumatic stress disorder (PTSD) is primarily characterized by re-experiencing traumatic events, avoidance behaviors, and hyperarousal, but not the distinct mood episodes seen in bipolar disorder. Delusional disorder is characterized by fixed false beliefs without the mood changes seen in bipolar disorder. Therefore, the correct answer is Bipolar disorder.

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