A patient diagnosed with major depressive disorder tells the nurse, 'Bad things that happen are always my fault.' To assist the patient in reframing this overgeneralization, how should the nurse respond?

Correct Answer: B

Rationale: In this scenario, option B is the most appropriate response for the nurse to assist the patient in reframing their overgeneralization. By suggesting to explore a specific event to identify alternative explanations, the nurse is guiding the patient towards critical thinking and challenging their automatic negative thoughts. This approach helps the patient recognize that not all bad outcomes are solely their fault, promoting a more balanced perspective. Option A is incorrect because it simply dismisses the patient's belief without offering a constructive alternative. This response may come off as invalidating and not supportive of the patient's feelings. Option C, while showing empathy, does not actively engage the patient in challenging their negative thought pattern. It acknowledges the patient's self-criticism but does not provide a strategy for cognitive restructuring. Option D is unrelated to the patient's statement and does not address the overgeneralization presented. Bringing up the patient's belief in fate or cultural heritage does not directly assist in reframing the negative thought pattern the patient is experiencing. Educationally, this question highlights the importance of active listening and therapeutic communication skills in nursing practice. It emphasizes the role of nurses in guiding patients towards more adaptive thought processes and promoting mental well-being through cognitive restructuring techniques. By understanding the rationale behind each response, nurses can enhance their ability to support patients with mental health challenges effectively.

Correct Answer: B

Rationale: In this scenario, the correct nursing diagnosis for the patient expressing feelings of failure is option B) Hopelessness. Major depressive disorder often manifests with feelings of hopelessness, helplessness, and worthlessness. By selecting this diagnosis, the nurse acknowledges the patient's emotional state and can initiate appropriate interventions to address these feelings and promote mental health. Option A) Powerlessness may not be the most appropriate diagnosis in this case as the patient is expressing feelings of failure rather than lack of control over their situation. Option C) Imbalanced nutrition: Less than body requirements is not relevant to the patient's statement about feeling like a failure. Option D) Risk for suicide, while important to assess in patients with major depressive disorder, is not the most appropriate initial nursing diagnosis based solely on the patient's statement about feeling like a failure. In an educational context, understanding how to accurately identify and prioritize nursing diagnoses is crucial for providing effective care to patients. By choosing the correct nursing diagnosis, nurses can tailor their interventions to address the specific needs of each individual patient, promoting holistic care and positive patient outcomes.

Correct Answer: B

Rationale: In this scenario, the correct answer is option B, which is the newly admitted client who has bipolar I disorder. The rationale behind this choice lies in the acuity and potential risk associated with bipolar I disorder. This condition can involve severe mood swings, including manic episodes that may require immediate attention to ensure the safety of the client and others. Option A is incorrect because premenstrual dysphoric disorder, while significant, does not typically present an immediate threat to the client's safety that would necessitate urgent intervention. Option C, the client with disruptive mood dysregulation disorder, is also less urgent as this disorder is characterized by chronic irritability rather than acute mood disturbances that require immediate attention. Option D, the client with a history of dysthymic disorder, is not the priority as this condition is a persistent depressive disorder that does not typically involve the same level of acuity as bipolar I disorder. From an educational perspective, this question highlights the importance of prioritizing care based on the acuity of the client's condition. It emphasizes the need for nurses to assess and manage clients with more acute and potentially dangerous conditions first to ensure their safety and well-being.

Correct Answer: D

Rationale: In this scenario, the correct answer is option D: Displaying extreme mood swings. This behavior is a potential warning sign of suicide because extreme mood swings, especially sudden shifts from extreme sadness to extreme calmness, can indicate an individual struggling with significant emotional distress. Option A, seeking a tutor for help with a challenging class, is a healthy and proactive behavior that shows a student's willingness to seek academic support. While academic struggles can contribute to stress, it is not typically a direct warning sign of suicide. Option B, volunteering at a homeless shelter, demonstrates empathy and community involvement. Engaging in volunteer work is generally a positive behavior that promotes social connection and a sense of purpose, factors that can actually protect against suicide. Option C, making plans to go to a high school dance, is a typical social activity for high school students. While changes in social behavior can sometimes be linked to mental health issues, simply attending a dance is not a specific warning sign of suicide. In an educational context, it is crucial for nurses and educators to be able to identify potential warning signs of suicide in students. By recognizing behaviors such as extreme mood swings, professionals can intervene early and connect students to appropriate support services to prevent tragic outcomes. Providing this knowledge equips school staff to create a safe and supportive environment for students' mental health and well-being.

Correct Answer: C

Rationale: In this scenario, option C, "It may take several weeks for the full effects of the medication to be felt," is the correct choice for the nurse to include in the patient's teaching plan. This is because fluoxetine, like other selective serotonin reuptake inhibitors (SSRIs), typically takes a few weeks to reach its full therapeutic effect in treating major depressive disorder. It is crucial for the patient to understand that immediate improvement in symptoms is unlikely and that adherence to the medication regimen is essential for long-term benefits. Option A, stating that the patient may experience drowsiness and sedation during the day, is not a priority teaching point for fluoxetine. While these side effects can occur, they are more commonly associated with other medications and typically diminish over time with continued use. Option B, suggesting that the patient may notice improvement in mood within a few hours, is inaccurate and misleading. Immediate mood improvement is not expected with fluoxetine and may lead to unrealistic expectations and premature discontinuation of the medication. Option D, advising the patient to take the medication with food to reduce stomach upset, is a general recommendation for SSRIs but is not as critical as understanding the delayed onset of therapeutic effects. It is important to address potential side effects and optimal administration, but the timeline for experiencing the full benefits of the medication takes precedence in educating the patient effectively. In an educational context, this question highlights the importance of providing accurate information to patients regarding their medication regimen. Nurses play a crucial role in patient education, empowering individuals to make informed decisions about their health. By understanding the pharmacokinetics and expected outcomes of medications, patients can better manage their conditions and adhere to treatment plans for improved health outcomes.