Population Based Health Care

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A 35-year-old woman who is being interviewed by the advanced practice nurse indicates that she has few friends, fears criticism from others, and withholds information about her thoughts and feelings because she anticipates a negative reaction. Based on these data, the nurse suspects that Sarah may later be diagnosed as having:

  • A. Borderline personality disorder
  • B. Histrionic personality disorder
  • C. Avoidant personality disorder
  • D. Schizoid personality disorder
Correct Answer: C

Rationale: The correct answer is C: Avoidant personality disorder. This is because the woman's fear of criticism, reluctance to share thoughts and feelings, and limited social interactions are characteristic of avoidant personality disorder. Individuals with this disorder have intense feelings of inadequacy, fear of rejection, and avoid situations where they may be criticized or judged.

Choice A: Borderline personality disorder is not the correct answer because individuals with borderline personality disorder typically have unstable relationships, impulsivity, and a fear of abandonment.

Choice B: Histrionic personality disorder is not the correct answer as individuals with this disorder seek attention and exhibit dramatic and attention-seeking behavior, which is not indicated in the scenario.

Choice D: Schizoid personality disorder is not the correct answer as individuals with this disorder tend to have a limited range of emotional expression and lack interest in forming social relationships, which does not align with the woman's fear of criticism and desire to avoid negative reactions.

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A client in her early teens who is being treated for irritable bowel syndrome has just disclosed that she has been feeling anxious. For what other condition should the nurse assess this client?

  • A. Anxiety.
  • B. Depression.
  • C. Eating disorder.
  • D. None of the above.
Correct Answer: A

Rationale: Step 1: The client disclosed feeling anxious.
Step 2: Anxiety is a common comorbidity with irritable bowel syndrome.
Step 3: Assessing for anxiety allows for holistic treatment.
Step 4: Anxiety can impact the client's physical health.
Step 5: Therefore, assessing for anxiety is crucial.
Summary:
B: Depression - While depression is important, the client disclosed anxiety.
C: Eating disorder - Not directly related to the client's disclosure.
D: None of the above - Incorrect, as assessing for anxiety is necessary.

Prior to discharge, the nurse plans to teach the client and family about relapse. Which items will the nurse include in the teaching?

  • A. Recognition of warning signs of relapse
  • B. Notify the nurse of warning signs present for more than one month
  • C. Lower medication dosage to manage emerging side effects
  • D. Use street drugs judiciously and only in small amounts
Correct Answer: A

Rationale: The correct answer is A because recognizing warning signs of relapse is crucial for early intervention. By identifying these signs, the client and family can seek help promptly, preventing a full relapse. Choice B is incorrect as waiting for signs to persist for more than one month delays intervention. Choice C is incorrect as altering medication dosage without medical advice can be dangerous. Choice D is incorrect as using street drugs is never a safe or appropriate way to manage relapse.

The quality of life of people with intellectual disabilities can be improved significantly with the help of basic training procedures that will equip them with a range of skills depending on their level of disability. The application of learning theory to training in these areas is also known as:

  • A. Applied cognitive approaches
  • B. Applied treatment analysis
  • C. Cognitive behavioural therapy
  • D. Applied behaviour analysis
Correct Answer: D

Rationale: Applied Behaviour Analysis: Applying principles of learning theory, particularly operant conditioning, to improve skills in individuals with intellectual disabilities.

A severely depressed patient with psychomotor retardation has begun activities therapy. His schedule is: 9 AM, ceramics; 10 AM, exercise group; 11 AM to noon, open; noon, lunch. The nurse creating the patient's schedule should opt to fill the hour block from 11 AM to noon with:

  • A. Group therapy.
  • B. A rest period.
  • C. Reminiscence group.
  • D. Individual counseling.
Correct Answer: B

Rationale: The correct answer is B: A rest period. Providing a rest period during the hour block from 11 AM to noon is crucial for a severely depressed patient with psychomotor retardation. This patient may experience fatigue and decreased energy levels due to their condition. Allowing for a rest period can help prevent overstimulation and promote relaxation, which is essential for mental well-being. Group therapy (choice A) may be too overwhelming for the patient at this time. Reminiscence group (choice C) may not be as beneficial for immediate symptom management. Individual counseling (choice D) may be helpful but may not align with the patient's immediate need for rest and relaxation.

A patient who has been physically abused says, 'When I called the police, I just wanted my spouse to stop shoving me around and kicking me. I didn't want anyone to get in trouble. It's easy to get angry with me because I spend too much money.' Which nursing intervention would be most therapeutic for this patient?

  • A. You feel your spouse was justified in the abuse because you overspent?'
  • B. Tell your spouse that if this happens again, I'll report it to the police.'
  • C. Your spouse abuses you when you overspend. So you think it will stop if you stop spending money?'
  • D. I can understand that you don't want to press charges, but your spouse needs help controlling anger.'
Correct Answer: A

Rationale: The correct answer is A because it focuses on therapeutic communication by reflecting the patient's feelings and thoughts back to them without judgment. By repeating the patient's words, the nurse shows empathy and understanding, which can help build trust and rapport. Choices B and D may escalate the situation and go against the patient's wishes, potentially causing further harm. Choice C assumes a causal relationship between overspending and abuse, which is not appropriate and may blame the victim. Overall, choice A promotes a non-judgmental and supportive environment, which is crucial in addressing issues of abuse.

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