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Tammy, a 28-year-old with major depressive disorder and bulimia nervosa, is ready for discharge from the county hospital after 2 weeks of inpatient therapy. Tammy is taking citalopram (Celexa) and reports that it has made her feel more hopeful. With a secondary diagnosis of bulimia nervosa, what is an alternative antidepressant to consider?
- A. Fluoxetine (Prozac)
- B. Isocarboxazid (Marplan)
- C. Amitriptyline
- D. Duloxetine (Cymbalta)
Correct Answer: A
Rationale: Fluoxetine (Prozac) is a suitable alternative antidepressant for Tammy due to its approval for the treatment of bulimia nervosa. It belongs to the selective serotonin reuptake inhibitor (SSRI) class of antidepressants, similar to citalopram, which Tammy is already taking. Fluoxetine has shown efficacy in treating bulimia nervosa and can be a beneficial choice for individuals with this condition.
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An individual who has survived incest and is receiving treatment at the mental health clinic feels relief upon understanding that her anxiety and depression are:
- A. Going to be eradicated with treatment
- B. Normal and will soon pass
- C. Abnormal but will pass
- D. A normal reaction to posttraumatic events
Correct Answer: D
Rationale: It is important to recognize that anxiety and depression are common responses to traumatic events like incest. Understanding that these feelings are normal reactions can help validate the individual's experiences and reduce stigma. By acknowledging that anxiety and depression are expected outcomes of posttraumatic events, the mental health clinic can provide appropriate support and treatment to help the survivor cope and heal. Therefore, option D is the correct choice as it reflects a compassionate and informed approach to addressing the survivor's emotional struggles.
Therapeutic communication is the foundation of a patient-centered interview. Which of the following techniques is not considered therapeutic?
- A. Restating
- B. Encouraging description of perception
- C. Summarizing
- D. Asking 'why' questions
Correct Answer: D
Rationale: Asking 'why' questions is not considered a therapeutic technique in patient-centered communication as it can make patients feel defensive or judged. 'Why' questions may imply criticism or put the patient on the spot, potentially hindering open and honest communication. Instead, focusing on open-ended questions that encourage patients to express their feelings and thoughts without feeling judged or interrogated is more conducive to therapeutic communication.
Pablo is a homeless adult who has no family connection. Pablo passed out on the street, and emergency medical services took him to the hospital where he expresses a wish to die. The physician recognizes evidence of substance use problems and mental health issues and recommends inpatient treatment for Pablo. What is the rationale for this treatment choice? Select one that doesn't apply.
- A. Intermittent supervision is available in inpatient settings.
- B. He requires stabilization of multiple symptoms.
- C. How do you feel about talking to a mental health counselor?
- D. Medication adherence will be mandated.
Correct Answer: D
Rationale: The correct answer is D because medication adherence being mandated is not a primary rationale for inpatient treatment. The main reasons for recommending inpatient treatment in this scenario include the need for stabilization of multiple symptoms, addressing nutritional and self-care needs, and ensuring safety due to the imminent danger of self-harm. Inpatient settings provide a more intensive level of care and supervision to address these complex issues effectively.
When using therapeutic communication with a withdrawn patient who has major depression, an effective method of managing the silence is to:
- A. Engage in a quiet meditation
- B. Ask simple questions even if the patient will not answer
- C. Use the technique of making observations
- D. Simply sit quietly and leave when the patient falls asleep
Correct Answer: C
Rationale: Using the technique of making observations is an effective method of managing silence when communicating with a withdrawn patient who has major depression. This approach can encourage the patient to engage and feel understood without the pressure to respond, fostering a therapeutic connection and helping the patient open up at their own pace.
A woman was abducted and raped at gunpoint by an unknown assailant. When found, she was confused and disoriented. The nurse makes the following observations about the client. She is talking rapidly in disjointed phrases, is unable to concentrate, and is indecisive when asked to make simple decisions. The client's level of anxiety can be assessed as
- A. moderate
- B. severe
- C. mild
- D. nonexistent
Correct Answer: B
Rationale: The client's presentation, including rapid and disjointed speech, inability to concentrate, and indecisiveness, are indicative of severe anxiety. These symptoms suggest a high level of distress and impairment in cognitive functioning, which aligns with severe anxiety rather than mild or moderate levels. The traumatic experience of being abducted and raped at gunpoint would likely contribute to such a severe level of anxiety.