Nokea
A client who caused a house fire by leaving a pot on the stove often returns home to recheck the burners. The nurse understands this action is performed for which main purpose?
- A. To eliminate guilty feelings
- B. To alleviate anxiety
- C. To compensate for forgetfulness
- D. To avoid a tragedy
Correct Answer: B
Rationale: This is a symptom of OCD, and the tension-relieving act is performed to reduce anxiety. Guilt feelings are more associated with PTSD or for surviving an event when others died. Although turning off burners may help to avoid another tragedy, the repetition is done to help terminate the persistent thoughts and decrease the anxiety. Repetition is not indicated for forgetfulness.
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The client is brought to the emergency department with complaint of chest pain, rapid breathing, and palpitations. Cardiovascular event is ruled out, and the client is diagnosed with acute panic attack. The client seems embarrassed and states, 'I thought I was going to die.' Which is the best response from the nurse?
- A. It must have been frightening for you.
- B. Chest pain should always be evaluated.
- C. We would not let you die.
- D. But you are okay now.
Correct Answer: A
Rationale: It must have been frightening' is an empathetic statement that validates the feelings of the client and acknowledges the symptoms experienced. This is a therapeutic response and conveys respect, self-worth, and caring. Chest pain should always be evaluated, but this comment is factual not emotionally supportive. Other statements are not indicated as therapeutic or caring.
A nurse stops at the scene of an accident and attempts to assist a client who is lying in an overturned vehicle. When the nurse crawls into the vehicle, the client starts screaming 'incoming, incoming' and is violently thrashing and attempting to kick the nurse. Which is the best interpretation by the nurse?
- A. The client is diagnosed with post-traumatic stress disorder.
- B. The accident has triggered a flashback.
- C. The accident is a result from psychic numbing.
- D. Alcohol use disorder caused the accident.
Correct Answer: B
Rationale: The crash situation has brought about a flashback to a previous trauma in the experience of this client. The client is probably dealing with PTSD but this cannot be assumed as a diagnosis by the nurse. Psychic numbing is not indicated. Although it is not unusual for clients who suffer from PTSD to use alcohol or other substances to suppress symptoms, it cannot be assumed that any alcohol was used in this instance or is the root of the accident.
One week ago, the client was prescribed Buspirone (Buspar) for anxiety. The client phones the office and reports the medication has not eliminated the symptoms. Which is the best response by the nurse?
- A. It may take up to 4 weeks for full therapeutic response.
- B. There are many other medications that can be offered.
- C. Buspar will not eliminate all symptoms associated with anxiety.
- D. Call back in one week if the symptoms continue.
Correct Answer: A
Rationale: Buspirone (Buspar) may take 2 to 4 weeks to produce desired effects. Clients should be provided this information at the time of initial administration. Changing to another medication would not be indicated at this time. Suggesting that the symptoms may not be eliminated is not indicated and should be avoided. Listening to and validating the client's concerns is a therapeutic measure.
Which type of therapy assists the clients to alter their irrational thinking?
- A. Psychopharmacology
- B. Desensitization
- C. Behavioral Therapy
- D. Cognitive Therapy
Correct Answer: D
Rationale: Cognitive therapy is a type of psychotherapy in which the therapist helps clients alter their irrational thinking, correct their faulty belief systems, and replace negative self-statements with positive ones. Desensitization involves providing emotional support while gradually exposing a person to whatever it is that provokes anxiety. Behavioral therapy attempts to extinguish undesirable responses by learning other adaptive techniques. Psychopharmacology is the use of medications to treat various disorders.
The Beer's List is helpful in providing the nurse with a quick reference on potential risks and benefits for which likely group of clients?
- A. Infants and children
- B. Older adults
- C. Chemically dependent
- D. Complex medical problem clients
Correct Answer: B
Rationale: Beer's criterion has been used to identify drugs that may be inappropriately prescribed, ineffective, or cause adverse drug reactions in older adult clients. The Beer's criteria are very useful and help determine risk-associated situations for older adults and specific drugs that may be problematic. Chemical dependency and complex medical problems are not a consideration.