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A 25-year-old individual was brought by ambulance to the emergency room. The patient's sensorium alternates between clouded and clear, and the patient becomes agitated both physically and verbally when approached. The patient's roommate states that the patient "was fine after getting up this morning but started talking crazy about 3 hours ago." The patient's cognitive impairment is most consistent with:

  • A. delirium.
  • B. dementia.
  • C. sundown syndrome.
  • D. early-onset Alzheimer disease.
Correct Answer: A

Rationale: The correct answer is A: delirium. Delirium is an acute change in mental status characterized by fluctuating levels of consciousness, inattention, disorganized thinking, and altered perception. In this case, the patient's clouded and clear sensorium, agitation, and recent onset of symptoms are indicative of delirium.

Choice B: dementia, is incorrect because dementia is a chronic, progressive decline in cognitive function that does not typically present with acute changes in mental status.

Choice C: sundown syndrome, is incorrect as it refers to a pattern of worsening confusion or agitation in the late afternoon or evening, not necessarily characterized by acute onset and fluctuating levels of consciousness.

Choice D: early-onset Alzheimer disease, is incorrect because Alzheimer's disease is a specific type of dementia that does not typically present with the acute and fluctuating symptoms described in the scenario.

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Which symptom reported by a client, age 35, who was sexually abused as a child reflects the diagnosis of posttraumatic stress disorder (PTSD)?

  • A. Reexperiencing the traumatic event
  • B. Refusing to go to public places from which escape may be difficult
  • C. Seeking advice and guidance prior to making any significant decision
  • D. Ruminating over the abuse with friends and acquaintances
Correct Answer: A

Rationale: The correct answer is A: Reexperiencing the traumatic event. This symptom is a key criterion for diagnosing PTSD according to the DSM-5. It includes flashbacks, nightmares, or intrusive thoughts related to the traumatic event. This symptom indicates that the client is experiencing distressing memories of the past abuse, which is a common feature of PTSD.

Choice B is incorrect because it describes agoraphobia, a separate anxiety disorder, not specific to PTSD. Choice C is incorrect as seeking advice is not a diagnostic criterion for PTSD. Choice D is incorrect because ruminating over the abuse with others may reflect coping mechanisms or seeking support, but it does not necessarily indicate PTSD.

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.

Disorders related to abnormal functioning of the sleep-wake cycle or timing mechanisms of the body are called:

  • A. Sleep apnea.
  • B. Primary sleep disorders.
  • C. Tertiary sleep disorders.
  • D. None of the above.
Correct Answer: B

Rationale: The correct answer is B: Primary sleep disorders. These disorders directly affect the sleep-wake cycle or timing mechanisms of the body. Sleep apnea (A) is a specific disorder characterized by pauses in breathing during sleep, not a general category. Tertiary sleep disorders (C) are not a recognized classification; the primary and secondary are the main categories. "None of the above" (D) is incorrect as primary sleep disorders are indeed related to abnormal functioning of the sleep-wake cycle.

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." 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

Which is a key nursing consideration when planning care for a patient with bulimia nervosa?

  • A. Allow the patient to choose their preferred food options.
  • B. Provide a structured environment with clear expectations around eating behaviors.
  • C. Monitor for signs of weight gain and decrease calorie intake accordingly.
  • D. Encourage the patient to participate in regular exercise routines.
Correct Answer: B

Rationale: The correct answer is B: Provide a structured environment with clear expectations around eating behaviors. This is important in managing bulimia nervosa as it helps establish a routine, promotes healthy eating habits, and prevents binge-purge cycles. It provides consistency and boundaries, reducing the likelihood of impulsive behaviors.

Incorrect choices:
A: Allowing the patient to choose their preferred food options can enable unhealthy eating patterns and reinforce disordered behaviors.
C: Monitoring for weight gain and decreasing calorie intake can worsen the patient's condition and perpetuate their obsession with weight and food.
D: Encouraging regular exercise routines may exacerbate the patient's unhealthy relationship with food and body image, leading to excessive exercising or compensatory behaviors.

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