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A 38-year-old woman, who had a subtotal thyroidectomy 8 years previously, is again thyrotoxic. Which one of the following is the most appropriate management?
- A. Perform total thyroidectomy after preparation with carbimazole.
- B. Radioactive iodine after preparation with oral iodine treatment.
- C. Prescribe immunosuppressive treatment with azathioprine.
- D. Control with cardimazole and then administration of radioactive iodine.
Correct Answer: D
Rationale: Recurrent thyrotoxicosis post-subtotal thyroidectomy is best managed with carbimazole to control symptoms, followed by radioactive iodine (D) for definitive treatment. Total thyroidectomy (A) is more invasive, iodine alone (B) is incorrect, immunosuppression (C) is irrelevant, and beta-blockers (E) are symptomatic only.
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A nurse is caring for a patient diagnosed with anorexia nervosa. What is the most important intervention during the refeeding phase?
- A. Monitor weight gain and provide a structured meal plan.
- B. Encourage the patient to eat independently without supervision.
- C. Focus on psychological therapy to address emotional issues.
- D. Offer the patient high-calorie, high-fat foods to increase intake.
Correct Answer: A
Rationale: The correct answer is A because during the refeeding phase of anorexia nervosa, monitoring weight gain and providing a structured meal plan are crucial to prevent refeeding syndrome and ensure a safe and gradual increase in caloric intake. This approach helps prevent complications such as electrolyte imbalances and organ dysfunction. Encouraging the patient to eat independently without supervision (B) can be harmful as they may not consume adequate or balanced nutrition. Psychological therapy (C) is important but not the most crucial during the refeeding phase. Offering high-calorie, high-fat foods (D) can lead to rapid weight gain and further complications.
A victim of spousal abuse comes to the emergency department for treatment of a broken arm. She appears hypervigilant and anxious and admits to sleep disturbance when the nurse questions the dark circles under her eyes. She reluctantly tells the nurse the abuse usually occurs when the husband has been drinking, although she concedes he is always jealous and controlling. She is a stay-at-home mother of two preschool children. The family has lived in this town for 1 month. The patient states she has fleetingly considered suicide but must stay alive to care for her children and work her way out of the abusive relationship. She denies any further suicidal thoughts. The nurse should document in the medical record that: (Select all that apply.)
- A. Signs of high anxiety and chronic stress are present.
- B. The patient relies on the perpetrator for basic needs.
- C. The patient has a history of suicidal ideation.
- D. None of the above.
Correct Answer: A
Rationale: The correct answer is A: Signs of high anxiety and chronic stress are present.
Rationale:
1. The patient displaying hypervigilance, anxiety, sleep disturbances, and dark circles under her eyes are indicators of high anxiety and chronic stress, common in victims of abuse.
2. Mentioning abuse occurring when the husband drinks, his jealousy, and control further support the presence of chronic stress and anxiety.
3. The patient's fleeting suicidal thoughts are a response to the abusive situation, not indicative of a history of suicidal ideation.
Summary:
B: The patient relying on the perpetrator for basic needs is not supported by the information provided.
C: There is no indication of a history of suicidal ideation, as the patient's thoughts are tied to her children and escaping the abusive relationship.
A delusion is defined as seeing something that is not real
- A. TRUE
- B. FALSE
Correct Answer: B
Rationale: A delusion is a fixed false belief, not a perception (hallucination involves seeing/hearing something not real).
A patient has schizophrenia and is troubled by negative symptoms, muscle stiffness, and motor restlessness. His Advanced Practice Nurse (APN) is considering changing the patient's antipsychotic medication, haloperidol (Haldol, a typical or first generation antipsychotic drug). For planning purposes, which medication can the nurse assume that the APN will probably choose?
- A. Chlorpromazine (Thorazine)
- B. Clozapine (Clozaril)
- C. Olanzapine (Zyprexa)
- D. Fluoxetine (Prozac)
Correct Answer: C
Rationale: The correct answer is C: Olanzapine (Zyprexa). Olanzapine is an atypical or second-generation antipsychotic known for effectively treating negative symptoms, muscle stiffness, and motor restlessness in schizophrenia. It has a lower risk of extrapyramidal side effects compared to typical antipsychotics like haloperidol. Chlorpromazine (A) is a typical antipsychotic with similar side effect profiles as haloperidol. Clozapine (B) is an atypical antipsychotic but is typically reserved for treatment-resistant cases due to its potential for serious side effects. Fluoxetine (D) is an antidepressant and not typically used for treating the symptoms described in the question. Therefore, the APN will likely choose Olanzapine to address the patient's symptoms effectively with a lower risk of side effects.
A frequent finding in clients with Paraphiliac sexual disorders is that they have:
- A. Other covert or overt emotional
- B. Gonadal and pituitary hormone deficiencies
- C. An inadequate physical development of the sex organs
- D. A poor adjustment due to association with society's fringe groups
Correct Answer: A
Rationale: Clients with paraphilic disorders often have coexisting emotional disorders, which may contribute to or result from their condition.