The nurse is caring for a patient diagnosed with Bipolar I who tells the nurse that frequent admissions for severe mania have adversely impacted their children and family. The nurse feels consumed with worry, concern, and has intrusive thoughts about the patient's family and their situation. The nurse recognizes that she is experiencing:

Acute stress disorder.

Derealization disorder.

Compassion fatigue.

Dissociative disorder.

Answer and Explanation

The Correct Answer is C

Choice A reason: Acute stress disorder involves trauma-related symptoms like dissociation or hyperarousal following a traumatic event, driven by amygdala hyperactivity and cortisol dysregulation. The nurse’s symptoms stem from emotional overload, not personal trauma, making this diagnosis inappropriate, as it does not involve direct exposure to a traumatic stressor.

Choice B reason: Derealization disorder involves persistent feelings of unreality or detachment, linked to altered temporoparietal neural activity. The nurse’s symptoms of worry and intrusive thoughts about the patient’s family reflect emotional exhaustion, not perceptual distortions, making derealization unrelated to the described empathetic overload.

Choice C reason: Compassion fatigue results from chronic exposure to patients’ suffering, leading to emotional exhaustion and intrusive thoughts. It involves burnout-related changes in cortisol and serotonin signaling, impairing emotional regulation in the prefrontal cortex. The nurse’s excessive worry about the patient’s family aligns with this stress-induced condition.

Choice D reason: Dissociative disorder involves disruptions in identity or memory, often linked to trauma and altered hippocampal-amygdala connectivity. The nurse’s symptoms are emotional, not dissociative, stemming from empathetic overload rather than trauma-induced neural changes, making this diagnosis irrelevant to the described scenario.

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Correct Answer is D

Explanation

Choice A reason: This response dismisses the client’s delusion, potentially increasing agitation. Schizophrenia’s mesolimbic dopamine excess drives delusional beliefs, and invalidation can heighten amygdala-driven distress, disrupting therapeutic rapport and failing to address the emotional impact of the psychotic experience.

Choice B reason: Labeling the client’s thinking as illogical is confrontational, risking escalation of paranoia. Dopamine hyperactivity in schizophrenia sustains delusions, and challenging them directly may increase amygdala activation, worsening distress and undermining trust in the therapeutic relationship.

Choice C reason: Stating the client has a thought disorder is non-therapeutic, as it dismisses the delusion without empathy. Schizophrenia’s dopamine-driven delusions require validation of feelings to reduce amygdala hyperactivity, not intellectual correction, which may alienate the client and hinder engagement.

Choice D reason: Acknowledging the delusion’s emotional impact without affirming it validates the client’s distress, reducing amygdala-driven anxiety. This therapeutic approach aligns with schizophrenia’s dopamine dysregulation, fostering trust and engagement by addressing the emotional experience of the delusion empathetically.

A. Attachment-Based Therapy and Mirtazapine (Remeron). B. Dialectical Behavior Therapy and Lorazepam (Ativan). C. Cognitive Processing Therapy and Sertraline (Zoloft). D. Applied Behavior Analysis and Atomoxetine (Strattera).

Correct Answer is C

Explanation

Choice A reason: Attachment-Based Therapy focuses on interpersonal relationships, not trauma-specific processing, and is less effective for PTSD’s amygdala-driven fear memories. Mirtazapine enhances serotonin and norepinephrine but lacks strong evidence for PTSD, as it primarily addresses depression by modulating alpha-2 adrenergic receptors, not trauma-specific neural hyperactivity.

Choice B reason: Dialectical Behavior Therapy targets emotional regulation for personality disorders, not PTSD’s trauma-specific memories. Lorazepam, a benzodiazepine, enhances GABA activity but is not recommended for PTSD, as it may suppress rather than process trauma-related amygdala hyperactivity, risking dependency and impairing long-term recovery.

Choice C reason: Cognitive Processing Therapy restructures trauma-related cognitive distortions, reducing amygdala hyperactivity and enhancing prefrontal control in PTSD. Sertraline, an SSRI, increases serotonin levels, stabilizing mood and reducing hyperarousal by modulating amygdala-prefrontal circuits, making it a first-line treatment for PTSD’s neurochemical and cognitive symptoms.

Choice D reason: Applied Behavior Analysis is used for autism, not PTSD, and does not address trauma-related neural changes. Atomoxetine, a norepinephrine reuptake inhibitor, targets ADHD by enhancing prefrontal norepinephrine but lacks efficacy for PTSD’s amygdala-driven fear responses, making it unsuitable for trauma treatment.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client tells the nurse that he has bugs in his brain and asks the nurse if the nurse can see them. Which response by the nurse is most therapeutic?

Correct Answer is D

Explanation

The nurse preparing to teach a patient diagnosed with post-traumatic stress disorder (PTSD) about recommended psychotherapy and psychopharmacology will discuss:

Correct Answer is C

Explanation

A nurse is preparing to administer methylprednisolone 10 mg IV bolus. The amount available from the pharmacy is 40 mg/mL. How many mL should the nurse administer? (Round to the nearest tenth.)

A client who has attempted suicide has an underlying diagnosis of depression. Based on the biochemical function that is most associated with suicidal behavior, the nurse anticipates which medication classification will be ordered for the client?

Which scenario best demonstrates an example of eustress?

The most appropriate response by the nurse when a despondent patient says "Nothing matters anymore" would be:

A nurse is preparing to administer acetaminophen 320 mg PO every four hours as needed for pain. The amount available from the pharmacy is acetaminophen liquid 160 mg/5 mL. How many mL should the nurse administer per dose? (Round to the nearest whole number.)

A nurse is conducting a visit to a client who is receiving palliative care at home for dying. The client’s husband tells the nurse, "I know she needs to be with God. That is the best place for her now." The client is experiencing which stage of Kubler-Ross’ stages of grieving?

During the initial interview at the crisis center, a patient says, "I’ve been served with divorce papers. I’m so upset and anxious that I can't think clearly." What could the nurse say to assess personal coping skills?