A patient reports, The medicine prescribed to help me get to sleep worked well for about a month, but I don't have any more of those pills. Now my insomnia is worse than ever. I had nightmares the last 2 nights. Which type of medication did the health care provider most likely prescribe?

Correct Answer: A

Rationale: The correct answer is A: Benzodiazepine. Benzodiazepines are commonly prescribed for short-term treatment of insomnia due to their sedative effects. The patient's initial positive response to the medication indicates it was likely a sedative-hypnotic drug like a benzodiazepine. The worsening insomnia and nightmares after discontinuation suggest withdrawal symptoms commonly seen with benzodiazepines. Tricyclic antidepressants (B) and conventional antipsychotics (C) are not typically used as first-line treatments for insomnia. Central nervous system stimulants (D) would exacerbate insomnia rather than improve sleep.

Correct Answer: A

Rationale: The correct answer is A. Before discharge, creating a behavioral contract with rules, rewards, and consequences is crucial for maintaining progress made in the residential program. This helps the adolescent and parents establish clear expectations and boundaries, promoting consistency and accountability. Choice B is incorrect because although having positive influences is important, it is not a specific outcome that must be achieved before discharge. Choice C is incorrect as it involves temporary placement with a foster family, which may not be necessary if the adolescent and parents can work together effectively. Choice D is incorrect as it sets an unrealistic and arbitrary expectation of experiencing no anger or frustration for a week, which may not be achievable or sustainable.

Correct Answer: C

Rationale: The correct answer is C: Defensive coping related to inappropriate methods of seeking parental attention as evidenced by acting out. This is the most applicable nursing diagnosis because the adolescent is using inappropriate methods (prostitution and assault) to seek attention due to feeling neglected by their parents. The adolescent's behavior is a manifestation of coping with their perceived lack of attention from their parents. A: Disturbed personal identity is incorrect because the primary issue is not related to personal identity but rather seeking attention. B: Hopelessness related to achievement of role identity is incorrect because the main issue is not feeling unloved but seeking attention through negative behaviors. D: Impaired parenting related to inequitable feelings toward children is incorrect as it focuses on the parents' behavior rather than the adolescent's coping mechanism.

Correct Answer: D

Rationale: The correct answer is D, providing dialectical behavioral therapy (DBT). Advanced practice nurses have specialized training and skills to provide psychotherapy interventions like DBT. DBT is an evidence-based therapy specifically designed to help individuals with impulse control disorders. Leading an activity group (choice A) and providing positive feedback (choice B) can be done by both advanced practice and staff nurses. Formulating nursing diagnoses (choice C) is within the scope of both roles but does not directly address the therapeutic intervention needed for impulse control disorders.

Correct Answer: A

Rationale: The correct answer is A: Parent-child interaction therapy (PCIT). PCIT focuses on improving parent-child communication and interactions, teaching parents effective discipline strategies, and enhancing the parent-child relationship. This therapy is specifically designed to help parents manage disruptive behaviors in children, such as conduct disorder (CD). By participating in PCIT, parents can learn skills to respond to rule-breaking behavior in a positive and effective manner, ultimately improving the child's behavior and family dynamics. Incorrect choices: B: Behavior modification therapy focuses on changing specific behaviors through reinforcement and punishment, but may not address the underlying parent-child relationship issues. C: Multi-systemic therapy (MST) targets various systems influencing the adolescent's behavior, but may not directly address the parents' need for guidance on managing rule-breaking behavior at home. D: Pharmacotherapy involves medication treatment, which may be used in conjunction with therapy but does not directly address the parents' need for guidance on responding to rule-breaking behavior.