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A 15-year-old boy presents with fatigue to the clinic. He reports that he is unable to wake up in the mornings and is missing a lot of school. On further questioning he reveals that he has some thoughts of suicide, but requests that the information be withheld from his parent who is in the waiting room. On examination he is noted to be obese with acanthosis. The next best step is to ensure his safety is:
- A. Refer to peds medicine for workup of obesity
- B. Breach confidentiality to inform his parent about the adolescents suicidal thoughts
- C. Refer to school for counselling
- D. Reassurance and diet and exercise advice
Correct Answer: B
Rationale: Suicidal thoughts indicate a safety risk, justifying breaching confidentiality to involve parents and ensure immediate intervention, per ethical and clinical guidelines.
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A rape victim tells the emergency room nurse, "I feel so dirty. Help me take a shower before the doctor examines me."Â The nurse should:
- A. Arrange for the patient to shower.
- B. Explain that bathing would destroy evidence.
- C. Give the patient a basin of water and towels.
- D. Explain that bathing facilities are not available in the emergency department.
Correct Answer: B
Rationale: The correct answer is B: Explain that bathing would destroy evidence. This is the correct choice because bathing can potentially wash away crucial forensic evidence that can be collected during a sexual assault examination. Preserving evidence is essential for legal proceedings and ensuring justice for the victim.
Choice A is incorrect because arranging for the patient to shower would destroy evidence. Choice C is incorrect as giving the patient a basin of water and towels would still risk destroying evidence. Choice D is also incorrect as it does not address the importance of preserving evidence in cases of sexual assault.
A 70-year-old woman is beginning to notice mild memory impairment. She fears she is developing dementia. What is the most likely cause of her memory impairment?
- A. Normal aging.
- B. Alzheimer's disease.
- C. Depression.
- D. None of the above.
Correct Answer: B
Rationale: The correct answer is B: Alzheimer's disease. This is the most likely cause of memory impairment in a 70-year-old woman experiencing mild memory issues. Alzheimer's disease is a progressive neurodegenerative disorder that affects memory, thinking, and behavior. It is the most common cause of dementia in older adults. Normal aging (choice A) typically involves some mild memory decline, but significant impairment is not considered a normal part of aging. Depression (choice C) can also impact memory, but in this case, the woman's primary concern is memory impairment, not depressive symptoms. Choice D is incorrect as Alzheimer's disease is a possible explanation for her memory issues.
A patient with bipolar disorder has rapid cycles. To prepare teaching materials, the nurse anticipates which medication will be prescribed?
- A. Clonidine (Catapres)
- B. Phenytoin (Dilantin)
- C. Carbamazepine (Tegretol)
- D. Chlorpromazine (Thorazine)
Correct Answer: C
Rationale: Rationale: Carbamazepine (Tegretol) is commonly used in treating rapid cycling bipolar disorder due to its mood stabilizing properties. It helps regulate mood swings and prevent manic or depressive episodes. It is effective in managing rapid cycling symptoms. Clonidine (A) is used for ADHD and hypertension, not bipolar disorder. Phenytoin (B) is an anticonvulsant, not typically used for bipolar disorder. Chlorpromazine (D) is an antipsychotic mainly for schizophrenia, not specifically indicated for rapid cycling in bipolar disorder.
An acutely psychotic individual diagnosed with schizophreniaform disorder at admission is immediately placed on daily doses of risperidone. A hospitalization of 8 days' duration has been authorized by the HMO. By what hospital day would the nurse expect to note that client was demonstrating beginning trust in the nurse and reduction in hallucinations and delusions?
- A. Day of admission
- B. Day 3 of hospitalization
- C. Day 5 of hospitalization
- D. Day 7 of hospitalization
Correct Answer: B
Rationale: The correct answer is B: Day 3 of hospitalization. Typically, antipsychotic medications like risperidone take a few days to start showing noticeable effects in reducing hallucinations and delusions. By day 3, the medication would have had enough time to begin its therapeutic effect. Building trust with a psychotic patient also takes time, so by day 3, the patient may start showing signs of trust in the nurse. Day of admission (Choice A) is too early for the medication to take effect. Day 5 (Choice C) and Day 7 (Choice D) are too late as the medication usually shows noticeable improvement within the first few days.
A client diagnosed with Alzheimer's disease has a catastrophic reaction during an activity involving simultaneous playing of music and working on a craft project. The client starts shouting 'no, no, no' and rushes out of the room. The nurse should:
- A. Isolate the client until she is calm, and then direct her back to the activity
- B. Follow the client, reassure her, and redirect her to a quieter activity
- C. Discontinue the activity program since it upsets the clients
- D. Give the client pm antianxiety medication and restrict her activity participation
Correct Answer: B
Rationale: The correct answer is B. The nurse should follow the client, reassure her, and redirect her to a quieter activity. This approach acknowledges the client's feelings and provides support to help her calm down. Isolating the client (Choice A) may escalate the situation and not address the underlying cause of the reaction. Discontinuing the activity program (Choice C) is not the best option as it may limit the client's engagement and therapeutic benefits. Giving medication and restricting activity (Choice D) should be a last resort and not the initial response to a behavioral reaction. In summary, Choice B focuses on comforting and redirecting the client, promoting a positive and supportive environment.