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A 19-year-old woman, prescribed a triphasic oral contraceptive for the first time one month ago, complains of frequent spotting. Which one of the following is the most appropriate management?
- A. Increase the dose of oestrogen.
- B. Increase the dose of progestogen.
- C. Advise alternative contraception.
- D. Continue the medication and review in two months.
Correct Answer: D
Rationale: Spotting is common in the first few months of oral contraceptives as the body adjusts. Continuing the medication and reviewing later (D) is standard, rather than immediate dose changes (A, B), switching methods (C, E) without trial.
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Which service would be expected to provide resources 24 hours a day, 7 days a week if needed for persons with serious mental illness?
- A. Clubhouse model
- B. Cognitive Behavioral Therapy (CBT)
- C. Assertive Community Treatment (ACT)
- D. Cognitive Enhancement Therapy (CET)
Correct Answer: C
Rationale: Assertive Community Treatment (ACT) (C) offers 24/7 multidisciplinary support in the patient's environment, unlike the Clubhouse model (A), CBT (B), or CET (D), which lack such availability.
Treatment of communication disorders is normally the domain of speech therapists and related disciplines, and a range of successful treatment programmes and equipment are available for disabilities such as phonological disorder and stuttering (Saltuklaroglu & Kalinowski, 2005; Law, Garrett & Nye, 2004). For example, hand-held equipment can provide which of the following?
- A. Significant auditory feedback (SAF)
- B. Magnified auditory feedback (MAF)
- C. Altered auditory feedback (AAF)
- D. Actual auditory feedback (AAF)
Correct Answer: C
Rationale: Altered Auditory Feedback (AAF): A treatment for stuttering providing delayed auditory feedback or frequency changes to improve speech fluency.
The nursing diagnosis most likely to be used for a person who has a diagnosis of schizophrenia, paranoid type, is:
- A. social isolation related to impaired ability to trust.
- B. impaired mobility related to fear of losing control of hostile impulses.
- C. fear of being alone related to lack of confidence in significant others.
- D. impaired memory related to poor information processing associated with brain deficits.
Correct Answer: A
Rationale: Step-by-step rationale for choice A:
1. Schizophrenia, paranoid type, involves mistrust and suspicion.
2. Impaired ability to trust can lead to social isolation.
3. "Impaired ability to trust" directly relates to social isolation.
4. Therefore, "social isolation related to impaired ability to trust" is the most likely nursing diagnosis.
Summary of other choices:
- B: Not directly related to mistrust in paranoid schizophrenia.
- C: Lack of confidence in significant others is not a defining characteristic of paranoid schizophrenia.
- D: Impaired memory is not a primary feature of paranoid schizophrenia.
The treatment team implements a behavior modification approach using a contract for a client with antisocial personality disorder. An expected outcome of this approach is that client will:
- A. Learn how to avoid punishment
- B. Explain why he breaks rules
- C. Comply with behaviors specified in the contract
- D. Develop empathy in interpersonal contacts with peers
Correct Answer: C
Rationale: The correct answer is C because compliance with the behaviors specified in the contract is a key goal of behavior modification. This outcome focuses on specific, observable behaviors that the client agrees to follow. This approach helps in setting clear expectations and consequences, which is beneficial for individuals with antisocial personality disorder.
Explanation for why the other choices are incorrect:
A: Learning how to avoid punishment may not necessarily lead to behavior change or compliance with the contract terms.
B: Explaining why he breaks rules may not necessarily result in actual behavior change or adherence to the contract.
D: Developing empathy is a more complex and long-term goal that may not directly relate to compliance with the contract terms.
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.