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?

“You have lost touch with reality, which is a symptom of your illness.”

“It sounds like you’re concerned about your privacy.”

“The government is prohibited from operating in health care facilities.”

“Let’s talk about something other than the government.”

Answer and Explanation

The Correct Answer is B

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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Correct Answer is D

Explanation

Choice A reason: Buspirone enhances serotonin activity, taking weeks to reduce anxiety. Panic attacks, driven by acute norepinephrine surges in the amygdala, require rapid intervention. Buspirone’s delayed onset makes it ineffective for acute symptom relief, unlike fast-acting options targeting immediate neurochemical imbalances.

Choice B reason: Venlafaxine, an SNRI, increases serotonin and norepinephrine over weeks, unsuitable for acute panic attacks. Panic involves rapid sympathetic activation, requiring immediate GABA enhancement or similar fast-acting mechanisms, not gradual reuptake inhibition, making venlafaxine incorrect for rapid relief.

Choice C reason: Imipramine, a tricyclic, modulates serotonin and norepinephrine but takes weeks to act. Acute panic, driven by locus coeruleus norepinephrine spikes, needs immediate relief. Imipramine’s slow onset and side effects make it inappropriate for rapid intervention in acute anxiety episodes.

Choice D reason: Alprazolam, a benzodiazepine, enhances GABA-A receptor activity, rapidly inhibiting excessive neural firing in the amygdala during panic attacks. This provides quick relief from acute anxiety symptoms, like tachycardia, within minutes, making it the correct choice for immediate neurobiological stabilization in panic episodes.

A. “Mental illness can be evidence of a brain disorder.” B. “Many mental illnesses are a result of genetic predisposition.” C. “Even children may have diagnosable mental health conditions.” D. “Mental illness is a result of the breakdown of the American family.”

Correct Answer is D

Explanation

Choice A reason: Linking mental illness to brain disorders, like dopamine imbalances in schizophrenia, is factual and reduces stigma by emphasizing neurobiological causes. This aligns with scientific understanding, not perpetuating blame or stereotypes, making it an incorrect choice for reflecting stigma.

Choice B reason: Genetic predisposition, such as serotonin transporter gene variations, is a scientific explanation for mental illness. This reduces stigma by highlighting biological causes, not personal failings, aligning with evidence-based understanding and making it an incorrect choice for stigmatizing mental illness.

Choice C reason: Recognizing mental illness in children, like ADHD with dopamine deficits, normalizes early diagnosis and treatment. This factual statement reduces stigma by acknowledging neurobiological conditions across ages, making it an incorrect choice for reflecting stigmatizing attitudes toward mental illness.

Choice D reason: Blaming mental illness on family breakdown ignores neurobiological causes, like serotonin or dopamine imbalances, and perpetuates stigma by implying personal or social failure. This judgmental view misrepresents scientific evidence, making it the correct choice for reflecting stigmatizing attitudes toward mental illness.

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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?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client is experiencing a panic attack. What medication will provide the quickest relief from acute severe anxiety symptoms?

Correct Answer is D

Explanation

Which statement most clearly reflects the stigma of mental illness?

Correct Answer is D

Explanation

Which remark by a patient indicates passage from the orientation phase to the working phase of a nurse-patient relationship?

After a client has been prescribed fluoxetine (Prozac) for a diagnosis of anxiety disorder, which of the following information should the nurse be sure to include in the client teaching?

The spouse of a patient who experiences delusions asks the nurse, “Are there any circumstances under which the treatment team is justified in violating the patient’s right to confidentiality?” What is the nurse’s best response?

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

Which of the following side effects is associated with the blockade of attachment of norepinephrine to alpha-1 receptors?

On the basis of current knowledge of neurotransmitter effects, a nurse anticipates that the treatment plan for a patient with memory difficulties may include medications designed to do what?

A patient discloses several concerns and associated feelings. If the nurse wants to seek clarification, which comment would be appropriate?

A nursing student says, “Little of what takes place on the behavioral health unit seems to be theory-based.” A nurse educates the student by identifying which is a common use of Sullivan’s theory on the inpatient psychiatric unit?