Nursing Elites

1. You have been working closely with a patient for the past month. Today he tells you he is looking forward to meeting with his new psychiatrist but frowns and avoids eye contact while reporting this to you. Which of the following responses would most likely be therapeutic?

• A. A new psychiatrist is a chance to start fresh; I'm sure it will go well for you.
• B. You say you look forward to the meeting, but you appear anxious or unhappy.
• C. I notice that you frowned and avoided eye contact just now. Don't you feel well?
• D. I get the impression you don't really want to see your psychiatrist—can you tell me why?

Correct answer: B

Rationale: Choice B is the most therapeutic response as it acknowledges the discrepancy between the patient's verbal statement and nonverbal cues. By addressing both the patient's expressed anticipation and the conflicting nonverbal cues of frowning and avoiding eye contact, the responder demonstrates attentiveness to the patient's emotional state and encourages further exploration of underlying feelings. This approach fosters open communication and helps the patient feel understood and supported.

2. Which statement by the patient indicates a need for further teaching regarding the treatment of major depressive disorder?

• A. I have been on this antidepressant for 3 days. I understand that the full effect may take weeks to occur.
• B. I am going to ask my nurse practitioner to discontinue my Prozac today and let me start taking a monoamine oxidase inhibitor tomorrow.
• C. I may ask to have my medication changed to Wellbutrin due to the problems I am having being romantic with my wife.
• D. I realize that there are many antidepressants and it might take a while until we find the one that works best for me.

Correct answer: B

Rationale: Choice B indicates a need for further teaching because the patient is planning to switch directly from Prozac, an SSRI, to a monoamine oxidase inhibitor (MAOI) without allowing for a washout period. This abrupt switch poses a risk of serotonin syndrome, which can be life-threatening. It is essential to educate the patient about the importance of consulting healthcare providers before changing medications to prevent potential adverse effects.

3. During a mental status examination, which of the following components should be included in the assessment? Select one that doesn't apply.

• A. Appearance and behavior
• B. Thought processes
• C. Mood and affect
• D. The greater the cultural distance from the mainstream of society, the greater the likelihood that the illness will be treated with sensitivity and compassion.

Correct answer: D

Rationale: During a mental status examination, key components to be assessed include the client's appearance and behavior, thought processes, mood and affect, and cognitive function. These components help in evaluating the client's mental health status. The statement about cultural distance and illness treatment is not a part of a mental status examination and is not relevant to the assessment of mental health. Choices A, B, and C are essential components of a mental status examination and contribute to a comprehensive evaluation of an individual's mental well-being.

4. A patient with major depressive disorder is being treated with electroconvulsive therapy (ECT). The nurse should monitor the patient for which common side effect?

• A. Memory loss
• B. Hypertension
• C. Weight gain
• D. Hyperglycemia

Correct answer: A

Rationale: Memory loss, especially short-term memory loss, is a common side effect associated with electroconvulsive therapy (ECT). During ECT treatment, the electrical currents passed through the brain can disrupt short-term memory formation. This side effect is usually temporary, but patients should be closely monitored for any changes in memory function during and after the treatment. Choices B, C, and D are incorrect because they are not commonly associated with ECT. Hypertension, weight gain, and hyperglycemia are not typically observed as side effects of ECT.

5. When a husband accuses his wife of infidelity, which situation would indicate to the nurse the husband's use of the ego defense mechanism of projection?

• A. The husband cries and stamps his feet, demanding that his wife be true to her marriage vows.
• B. The husband ignores the wife's continued absence from the home.
• C. The husband has already admitted to having an affair with a coworker.
• D. The husband takes out his marital frustrations through employee abuse.

Correct answer: C

Rationale: Projection is a defense mechanism where one attributes their unacceptable feelings or impulses to another person. In this scenario, the husband, by admitting to having an affair with a coworker, is projecting his infidelity onto his wife, indicating the use of the projection defense mechanism. Choice A is incorrect as it describes a different behavior, not projection. Choice B does not demonstrate projection but rather avoidance or denial. Choice D shows displacement of aggression, not projection.

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