A patient says to the nurse, “I dreamed I was pusillanimous. When I woke up, I felt emotionally drained, as though I hadn’t rested well.” Which comment would be appropriate if the nurse seeks clarification?

“Can you give me an example of what you mean by pusillanimous?”

“I understand what you’re saying. Bad dreams leave me feeling tired, too.”

“It sounds as though you were uncomfortable with the content of your dream.”

“So, all in all, you feel as though you had a rather poor night’s sleep?”

Answer and Explanation

The Correct Answer is A

Choice A reason: Clarifying “pusillanimous” seeks specific meaning, ensuring accurate understanding of the patient’s emotional state. Dreams reflecting fear or inadequacy may involve amygdala hyperactivity or serotonin imbalances. This promotes therapeutic communication, addressing emotional distress linked to neurobiological stress responses, making it the most appropriate response.

Choice B reason: Relating personal experience shifts focus from the patient, reducing therapeutic effectiveness. Emotional drainage, possibly tied to REM sleep disruptions or cortisol spikes, requires exploration, not nurse self-disclosure. This risks dismissing the patient’s unique neurobiological experience, making it inappropriate for clarification.

Choice C reason: Assuming discomfort generalizes the dream’s impact without clarifying “pusillanimous.” Emotional drainage may reflect amygdala-driven stress responses, but this response lacks specificity. Clarification requires direct exploration of the term to understand its emotional and neurobiological significance, making this less effective.

Choice D reason: Summarizing poor sleep oversimplifies the emotional drainage, potentially linked to serotonin dysregulation or heightened stress responses. It fails to explore “pusillanimous,” missing the dream’s specific emotional content. Clarification requires detailed inquiry into the term’s meaning, making this response inadequate.

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Correct Answer is A

Explanation

Choice A reason: Venlafaxine inhibits serotonin and norepinephrine reuptake, enhancing synaptic levels of these neurotransmitters in the prefrontal cortex and amygdala, improving mood and anxiety. This mechanism aligns with SNRIs, making it the correct choice for treating conditions like depression or anxiety with dual neurotransmitter modulation.

Choice B reason: Propranolol is a beta-blocker, reducing sympathetic activity by blocking norepinephrine at beta receptors, not reuptake. It treats physical anxiety symptoms, not mood via serotonin-norepinephrine pathways. This makes it incorrect for an SNRI, as it lacks reuptake inhibition properties.

Choice C reason: Amitriptyline, a tricyclic antidepressant, inhibits serotonin and norepinephrine reuptake but also affects other receptors, causing significant side effects. It is not classified as an SNRI due to its broader mechanism, making it an incorrect choice compared to venlafaxine’s specific SNRI action.

Choice D reason: Fluoxetine is an SSRI, selectively inhibiting serotonin reuptake, not norepinephrine. It enhances serotonin in mood-regulating areas like the hippocampus but lacks norepinephrine modulation, making it incorrect for an SNRI, which requires dual reuptake inhibition for broader neurotransmitter effects.

A. “You have lost touch with reality, which is a symptom of your illness.” B. “It sounds like you’re concerned about your privacy.” C. “The government is prohibited from operating in health care facilities.” D. “Let’s talk about something other than the government.”

Correct Answer is B

Explanation

Choice A reason: Labeling paranoia as a loss of reality, while accurate for dopamine-driven delusions, risks alienating the patient. Confronting beliefs directly can increase agitation, as the amygdala amplifies fear responses. A therapeutic response validates emotions, not challenges perceptions, making this less effective.

Choice B reason: Acknowledging privacy concerns validates the patient’s emotions without reinforcing delusions. This reduces anxiety, calming amygdala hyperactivity in paranoia, and builds trust. By focusing on feelings, not the delusion’s content, the nurse fosters a therapeutic alliance, aligning with evidence-based approaches for psychotic disorders.

Choice C reason: Stating government prohibition addresses the delusion’s content, potentially escalating agitation. Paranoia, driven by mesolimbic dopamine excess, resists factual correction. This risks confrontation, undermining trust and therapeutic rapport, making it less effective than validating emotions in managing psychotic symptoms.

Choice D reason: Redirecting to another topic avoids engaging with the patient’s emotional state, missing a therapeutic opportunity. Paranoia, linked to dopamine dysregulation, requires addressing underlying fears to reduce amygdala-driven anxiety. Ignoring the concern can increase mistrust, making this response less therapeutic.

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A patient says to the nurse, “I dreamed I was pusillanimous. When I woke up, I felt emotionally drained, as though I hadn’t rested well.” Which comment would be appropriate if the nurse seeks clarification?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client is prescribed a serotonin-norepinephrine reuptake inhibitor. The nurse would identify that which of the following will be prescribed?

Correct Answer is A

Explanation

A patient with paranoia states, “The state is monitoring us through the listening devices hidden in this room. Be careful what you say.” Which response by the nurse would be most therapeutic?

Correct Answer is B

Explanation

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