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A child, age 9, is being evaluated in the Emergency Department at the hospital. Her mother reports that the child fell down the stairs in her home. Her mother is with her and describes her as a 'clumsy kid.' The nurse practitioner suspects child abuse. Which of these findings indicates that physical abuse may be a chronic problem for the child?
- A. Bloody nose and blackened eyes
- B. Unhealed fractures revealed on x-ray
- C. Clinging to her mother as she attempted to leave
- D. Struggling with the staff that attempts to obtain a blood specimen
Correct Answer: B
Rationale: The correct answer is B - Unhealed fractures revealed on x-ray. This finding indicates chronic physical abuse as unhealed fractures suggest repeated trauma over time. This is concerning because chronic abuse can lead to severe physical and emotional consequences for the child.
A: Bloody nose and blackened eyes may indicate acute physical abuse, but not necessarily chronic abuse.
C: Clinging to her mother as she attempted to leave is a behavior often seen in children who are anxious or scared in a medical setting, but it does not specifically indicate chronic physical abuse.
D: Struggling with the staff that attempts to obtain a blood specimen could be a response to fear or discomfort with medical procedures, which does not definitively point to chronic abuse.
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A nurse is working with a patient diagnosed with bulimia nervosa. Which of the following would indicate the need for further education?
- A. I know that purging is harmful to my health, but I continue to do it.
- B. I feel better after purging, but I realize it is not a long-term solution.
- C. I can control my eating and purging behaviors without help from others.
- D. I am working with my healthcare team to improve my eating habits and emotional health.
Correct Answer: C
Rationale: The correct answer is C because it indicates a lack of awareness about the severity of the disorder. Choice A acknowledges the harm of purging but struggles to stop, showing insight. Choice B recognizes the temporary relief of purging but understands the need for a better solution. Choice D demonstrates active engagement with healthcare professionals for support. In contrast, choice C suggests overconfidence in managing the disorder independently, which can hinder recovery progress. It is crucial for individuals with bulimia nervosa to acknowledge the need for professional help and support.
Which of the following assessments is most appropriate for a patient with anorexia nervosa?
- A. Monitor fluid intake exclusively.
- B. Check weight daily without discussing it with the patient.
- C. Observe the patient's response to meals, including food refusal or purging behavior.
- D. Monitor for signs of vitamin and mineral deficiencies.
Correct Answer: C
Rationale: The correct answer is C because observing the patient's response to meals, including food refusal or purging behavior, is crucial in assessing the patient's eating habits and behaviors associated with anorexia nervosa. This assessment helps in understanding the patient's relationship with food and identifying any disordered eating patterns. Monitoring fluid intake exclusively (Choice A) is not sufficient as it overlooks the broader aspects of the patient's eating behaviors. Checking weight daily without discussing it with the patient (Choice B) can be triggering and may not provide a comprehensive understanding of the patient's eating disorder. Monitoring for signs of vitamin and mineral deficiencies (Choice D) is important but does not directly address the specific behaviors associated with anorexia nervosa.
A woman tells the nurse that her husband abuses her most often when he is intoxicated, just as his father had beaten him and his mother. The woman is aware of the location of a safe house and has considered leaving home with her two children, but she cites being brought up to believe 'you keep quiet and stay together, no matter what happens.' She states the husband is always apologetic and remorseful after an incident. What evidence exists that the husband is at risk of becoming a perpetrator of physical abuse? He:
- A. is unable to make lasting behavioral changes.
- B. was an abused child.
- C. is without a job.
- D. experiences remorse.
Correct Answer: B
Rationale: The correct answer is B because the husband's history of being abused as a child increases his risk of becoming a perpetrator of physical abuse. Research shows that individuals who have been abused are more likely to perpetrate abuse themselves. This is due to a cycle of violence where behaviors learned in childhood are repeated in adulthood. In this case, the husband's abusive behavior towards his wife mirrors his own upbringing where his father abused his mother. This pattern suggests that the husband may continue the cycle of abuse.
Choice A (is unable to make lasting behavioral changes) is incorrect because it does not directly correlate with the risk of becoming a perpetrator of physical abuse. Choice C (is without a job) is also incorrect as employment status does not necessarily indicate a propensity for abuse. Choice D (experiences remorse) is incorrect as feeling remorse after abusive incidents does not negate the risk of becoming a perpetrator of physical abuse.
A worker is characterized by her co-workers as 'painfully shy' and lacking in self-confidence. Her co-workers say she stays in her cubicle all day, never coming out for breaks or lunch. One day after falling on the ice in the parking lot, she goes to the nurse's office, where she apologizes for falling and mentions that she hopes the company will not fire her for being so clumsy. With which diagnosis is this presentation most consistent?
- A. Avoidant
- B. Dependent
- C. Histrionic
- D. Paranoid
Correct Answer: A
Rationale: The correct answer is A: Avoidant. This diagnosis is consistent because the worker exhibits characteristics of extreme shyness, lack of self-confidence, social avoidance, and fear of rejection or criticism. By apologizing excessively for a simple accident and expressing worry about being fired for it, the worker's behavior aligns with the avoidance of social situations and excessive concern about negative evaluation typical of Avoidant Personality Disorder.
Choice B: Dependent, does not fit as the worker is not displaying excessive need for others to take responsibility for major areas of her life.
Choice C: Histrionic, is not a match as this disorder is characterized by attention-seeking behavior, which is not evident in the worker's presentation.
Choice D: Paranoid, is not the correct diagnosis as the worker does not display distrust or suspiciousness towards others.
Which of the following is the first-line treatment for Anorexia Nervosa?
- A. Family-Based Therapy
- B. Cognitive Behavioural Therapy
- C. Psychodynamic therapy
- D. Humanistic therapy
Correct Answer: A
Rationale: Family-Based Therapy (FBT) is the evidence-based first-line treatment for Anorexia Nervosa in adolescents, per NICE and APA guidelines.