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A 17-year-old patient with anorexia nervosa has just been released from the hospital. To facilitate recovery at home, the psychiatric-mental health nurse instructs the family to:
- A. discourage the patient from sneaking food between meals, by unobtrusively reducing access to the kitchen
- B. encourage the patient's interest in menu planning, food magazines, and cooking lessons, by leaving information and materials around the house
- C. permit the patient to eat her meals privately to discourage family preoccupation with meals
- D. recommend that the patient joins in routine family meals and clears the dishes after dinner, even if they do not eat
Correct Answer: D
Rationale: Involving the patient in family meals normalizes eating behavior and provides structure, supporting recovery without enabling secrecy or avoidance.
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A patient, aged 77 years, has Alzheimer's disease and lives with her daughter. While checking her blood pressure at the clinic, the nurse noticed fresh bruises on the patient's palms and buttocks. The patient could not explain these bruises. The nurse discussed her observations with the daughter, who became defensive and said that her mother was very difficult to manage. She stated, "My mother is getting worse every week. She is not my mother anymore. She can't recognize me, and she wanders all night. We take turns because she has to be watched constantly. Last night I fell asleep, and she fell down the stairs while wandering."Â Which statement is most accurate?
- A. Reporting the injuries in this case is not indicated by available data.
- B. The nurse should report the injuries as suggestive of elder abuse.
- C. The nurse is only required to report the injury if the patient is incompetent.
- D. The nurse is legally required to report the injuries as possible abuse.
Correct Answer: A
Rationale: Step 1: The nurse observed bruises on the patient's palms and buttocks.
Step 2: The patient could not explain these bruises.
Step 3: The daughter mentioned the patient's worsening condition and the incident of falling down the stairs.
Step 4: The daughter's statement indicates the patient's deteriorating cognitive and physical abilities.
Step 5: The daughter's challenges in managing the patient are due to the progression of Alzheimer's disease.
Step 6: There is no explicit evidence or indication of elder abuse based on the provided information.
Step 7: Reporting the injuries without clear signs of abuse may harm the patient's relationship with the daughter.
Step 8: Therefore, the most appropriate action is not to report the injuries based on the available data to avoid potential harm.
Summary:
- Choice A is correct as reporting the injuries is not indicated by the available data.
- Choices B, C, and D are incorrect as there is no clear evidence of elder abuse in the scenario
A newly admitted elderly client seems to become confused and agitated every evening after dinner. This client most likely is suffering from:
- A. Alzheimer's disease
- B. Acute dementia
- C. Sundown syndrome
- D. Delirium
Correct Answer: C
Rationale: The correct answer is C: Sundown syndrome. This is a condition where elderly individuals experience confusion and agitation in the evening. The symptoms are typically more pronounced during this time of day. It is not Alzheimer's disease (A) as that is a progressive neurodegenerative disorder. Acute dementia (B) is not a recognized medical term and does not accurately describe the symptoms. Delirium (D) is an acute state of confusion that can occur at any time of day, not just in the evening like sundown syndrome.
During occupational therapy a young patient diagnosed with schizophrenia sits staring at a piece of paper. Which response is most therapeutic at this time?
- A. If you prefer to sit and stare for a time, it is acceptable for you to leave.'
- B. You seem immobilized by anxiety. Is there anything I can do to help?'
- C. Are you having trouble deciding where you want to glue that piece?'
- D. Rub the glue stick on the back of the paper.'
Correct Answer: D
Rationale: The correct answer is D because it provides a clear and simple directive that guides the patient on what to do next, promoting engagement in the therapeutic activity. By instructing the patient to rub the glue stick on the back of the paper, it helps redirect their focus and encourages participation in the task.
Choice A is incorrect as it allows the patient to disengage from the activity, which does not promote therapeutic progress. Choice B assumes the patient is anxious without evidence and may not address the core issue. Choice C is incorrect as it may not be relevant to the patient's current state and may further confuse or frustrate them.
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.
A child, aged 11 years, stays home from school to care for his siblings while his mother works, because the family cannot afford a babysitter. The home is cluttered and dirty. When asked about his parents, the child reluctantly reveals that he thinks his father does not like him very much because he calls him 'stupid' and says he can never do anything right. This should be assessed as:
- A. physical abuse.
- B. sexual abuse.
- C. emotional abuse.
- D. economic abuse.
Correct Answer: C
Rationale: Explanation:
C: Emotional abuse is the correct assessment as the father's behavior of calling the child 'stupid' and criticizing him can cause psychological harm. This behavior undermines the child's self-esteem and mental well-being. The child's reluctance to speak about his parents also indicates emotional distress.
Incorrect choices:
A: Physical abuse involves causing physical harm, which is not evident in the scenario.
B: Sexual abuse involves inappropriate sexual behavior, which is not indicated in the scenario.
D: Economic abuse involves financial control or exploitation, which is not the primary issue in this scenario.