A patient who has survived a motor vehicle accident has just learned that the passenger in the car has died. The survivor is unable to recall being in the car. The nurse on duty realizes that this is:

Correct Answer: A

Rationale: In this scenario, the correct answer is A) Dissociation. Dissociation is a defense mechanism where a person separates themselves from their thoughts, feelings, memories, or sense of identity to avoid emotional distress. In this case, the patient's inability to recall the car accident is a form of dissociation, which helps protect them from the overwhelming emotional trauma of the experience. Option B) Denial is the refusal to accept reality or acknowledge a distressing situation. While denial could be a possible response to trauma, in this case, the patient's inability to recall the event goes beyond simple denial and aligns more closely with dissociation. Option C) Regression is a defense mechanism where a person reverts to an earlier stage of development in the face of stress. This response is not characteristic of the patient's inability to recall the car accident. Option D) Transference is a psychoanalytic concept where feelings and attitudes from past relationships are unconsciously transferred onto the therapist or healthcare provider. This concept is not applicable to the scenario described. Educationally, understanding defense mechanisms like dissociation is crucial for psychiatric nurses as they work with patients who may exhibit various coping strategies. Recognizing and interpreting these mechanisms can help nurses provide appropriate care and support to patients experiencing emotional distress or trauma. It also underscores the importance of creating a safe and supportive environment for patients to process and cope with their experiences.

Correct Answer: B

Rationale: Postoperative dietary progression starts with NPO (2) to rest the GI tract, followed by clear liquids (3) to test tolerance, full liquids (1) for nutrition, and soft diet (4) as healing progresses (Option B: 2,3,1,4). Option A starts prematurely, Option C misorders full liquids and soft, and Option D reverses the sequence.

Correct Answer: B

Rationale: In the context of a patient who has undergone spinal anesthesia for an appendectomy, the correct position to prevent spinal headaches is option B: flat on the bed for 6 to 8 hours. Rationale for the correct answer: When a patient undergoes spinal anesthesia, there is a risk of developing a spinal headache due to leakage of cerebrospinal fluid from the dural puncture site. By keeping the patient flat on the bed for 6 to 8 hours post-procedure, gravity helps to reduce the leakage of cerebrospinal fluid, thus decreasing the risk of developing a spinal headache. Rationale for why the other options are wrong: A) Semi-Fowler's position does not provide adequate support to prevent cerebrospinal fluid leakage and subsequent spinal headaches. C) Placing the patient in a prone position is contraindicated as it can exacerbate cerebrospinal fluid leakage. D) The Modified Trendelenburg position, with the feet elevated higher than the head, can increase intracranial pressure and is not recommended for preventing spinal headaches. Educational context: Understanding the rationale behind positioning post-spinal anesthesia is crucial for nurses caring for patients in the perioperative setting. By knowing the correct positioning techniques, nurses can effectively prevent complications such as spinal headaches and provide optimal care to their patients. This knowledge is essential for nurses pursuing psychiatric nurse certification as they may encounter patients with a history of spinal anesthesia in various psychiatric settings where medical comorbidities are prevalent.

Correct Answer: B

Rationale: The correct answer is B) 200-1600 mA. In Electroconvulsive Therapy (ECT), the amount of current passed during a session is measured in milliamperes (mA). This range of 200-1600 mA is considered typical for an ECT session. ECT is a medical procedure used primarily in the treatment of severe major depression, bipolar disorder, and certain psychotic disorders. Option A) 100-300 mA is too low for an effective ECT session. The therapeutic effects of ECT are typically achieved with higher current levels. Option C) 200-1600 Amp is incorrect as it is in amperes, which is a much higher unit of electrical current measurement than milliamperes and would be dangerously high for a medical procedure like ECT. Option D) 50-60 mA is too low for an effective ECT session. The current needs to be higher to induce a seizure, which is the mechanism of action in ECT for therapeutic benefit. Understanding the correct current range used in ECT is crucial for psychiatric nurses providing care to patients undergoing this treatment. It ensures patient safety and treatment efficacy. As a psychiatric nurse, having this knowledge is essential for delivering quality care and understanding the rationale behind the treatment modalities used in psychiatric settings.

Correct Answer: C

Rationale: In this scenario, the correct answer is C) Losses. The nurse should address the issue of losses as a priority during the initial interview with the student. This is because the student has experienced significant life changes, such as transferring to a new university, difficulties in making friends, a breakup with a long-term boyfriend, and the onset of disordered eating behaviors. These losses can contribute to feelings of sadness, isolation, and low self-esteem, which may be triggering or exacerbating the student's disordered eating and interfering with her schoolwork. Addressing the losses allows the nurse to explore and validate the student's emotions, provide emotional support, and help her process and cope with these challenging life events. By acknowledging and addressing the losses, the nurse can help the student develop healthier coping strategies and work towards resolving underlying emotional issues that may be contributing to her disordered eating and academic difficulties. Regarding the other options: - A) Sleep patterns: While sleep patterns are important for mental health, in this case, the student's disordered eating and emotional distress are more immediate concerns that need to be addressed first. - B) School activities: While school activities are important, the student's emotional well-being and disordered eating behaviors take precedence as they are directly impacting her academic performance. - D) Menstrual irregularities: While important for overall health, menstrual irregularities are not the most pressing issue at this point; addressing the student's emotional struggles and disordered eating behaviors should take precedence. In an educational context, this question highlights the importance of assessing and addressing underlying emotional factors in psychiatric nursing. It emphasizes the need for nurses to identify and prioritize issues related to loss, emotional distress, and maladaptive coping mechanisms in individuals experiencing mental health challenges. By focusing on these priority issues, nurses can provide holistic care and support to promote the well-being and recovery of their patients.