Nokea
A patient tells the nurse, "My doctor prescribed Paxil (paroxetine) for my depression. I assume I'll have side effects like I had when I was taking Tofranil (imipramine)." The nurse's reply should be based on the knowledge that paroxetine is a:
- A. Selective norepinephrine reuptake inhibitor.
- B. Tricyclic antidepressant.
- C. MAO inhibitor.
- D. SSRI
Correct Answer: D
Rationale: The correct answer is D: SSRI. Paroxetine belongs to the class of selective serotonin reuptake inhibitors (SSRIs), which work by primarily increasing the levels of serotonin in the brain. This mechanism differs from tricyclic antidepressants like Tofranil (imipramine) and MAO inhibitors. SSRIs are known for having fewer side effects compared to tricyclic antidepressants and MAO inhibitors. Therefore, the nurse should inform the patient that the side effects experienced with Tofranil are not necessarily indicative of what they will experience with Paxil due to the different drug classes.
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Discharge planning begins for an elderly patient hospitalized for 2 weeks diagnosed with major depression. The patient needs ongoing assessment and socialization opportunities as well as education about medication and relapse prevention. The patient lives with a daughter, who works during the week. Select the best referral for this patient.
- A. Behavioral health home care
- B. A skilled nursing facility
- C. Partial hospitalization
- D. A halfway house
Correct Answer: C
Rationale: Partial hospitalization will provide services the patient needs as well as give supervision and meals to the patient while the daughter is at work. Home care would not provide socialization. The patient does not need the intensity of a skilled nursing facility. A halfway house provides 24-hour care and usually expects involvement in off-campus programs.
A 45-year-old married woman who works full time in a factory has recently been absent for 3-day periods on several occasions. Each time, she returned to work wearing dark glasses. Facial and body bruises were apparent. Her supervisor became suspicious that she was a victim of battering and referred her to the occupational health nurse. Which initial inquiry would be most important for the nurse to make?
- A. Tell me what has happened to you.'
- B. Did your husband beat you?'
- C. Why do you let this happen?'
- D. What can you do to prevent this?'
Correct Answer: A
Rationale: The correct answer is A: "Tell me what has happened to you." This open-ended question allows the woman to share her experience without judgment or assumptions. It shows empathy and respect for her autonomy. It is crucial for the nurse to gather information directly from the patient to understand the situation fully and provide appropriate support.
Choice B is incorrect because it assumes the woman's husband is the perpetrator without giving her a chance to disclose the information herself. This can be intimidating and may not lead to a truthful response.
Choice C is incorrect because it implies blame on the victim for the abuse, which is not appropriate. It does not focus on providing support or understanding the situation.
Choice D is incorrect as it puts the responsibility on the victim to prevent the abuse, which is not a helpful approach. The focus should be on providing support and understanding the victim's situation.
A nurses neighbor says, 'My sister has been diagnosed with bipolar disorder but will not take her medication. I have tried to help her for over 20 years, but it seems like everything I do fails. Do you have any suggestions?' Select the nurses best response.
- A. The National Alliance on Mental Illness offers a family education series that you might find helpful.'
- B. Since your sister is noncompliant, perhaps its time for ber to be changed to injectable medication.'
- C. You have done all you can. Now its time to put yourself first and move on with your life.'
- D. You cannot help her. Would it be better for you to discontinue your relationship?'
Correct Answer: A
Rationale: The National Alliance on Mental Illness (NAMI) offers a family education series that assists with the stress caregivers and other family members often experience. The nurse should not give advice about injectable medication or encourage the family member to give up on the patient.
Which of the following would be the first priority for nurses caring for autistic children?
- A. Assist the psychiatrist and mental health team in providing treatments to cure the disorder
- B. Determine which of the two different types of autism the child has
- C. Discourage and prevent self-destructive behavior
- D. Provide behavior modification tools, specifically limit setting and reward systems
Correct Answer: C
Rationale: Safety is the primary nursing intervention. Behavior modification tools are important, but safety comes first. Autism at this point is not curable. Determining the type of autism is not a nursing goal.
A psychiatric technician remarks to the nurse, 'That client with dependent personality disorder is so clingy! I almost hate to see her coming my way.' The response by the nurse that will be helpful to the technician is:
- A. I think everyone feels that way. It's difficult to have someone clinging.'
- B. Clients with personality disorders have little regard for the rights of others.'
- C. The client fears having to function independently without direction from someone else.'
- D. The client is so preoccupied with perfection and structure that she's afraid to do anything at all.'
Correct Answer: C
Rationale: The correct answer is C: The client fears having to function independently without direction from someone else. This response is helpful because it provides insight into the underlying fear and motivation of the client's behavior. Clients with dependent personality disorder often have an excessive need to be taken care of and fear being alone or making decisions independently. This response acknowledges the client's struggle with autonomy and offers understanding without judgment.
Choice A is incorrect because it normalizes the technician's negative feelings, which does not address the client's needs. Choice B is incorrect because it makes a generalizing and negative statement about clients with personality disorders, which is stigmatizing and unhelpful. Choice D is incorrect because it describes features more commonly associated with obsessive-compulsive personality disorder, not dependent personality disorder.