Nokea
A 67-year-old woman recently noticed a non-painful lump in the right breast (see image). Which one of the following is the most likely diagnosis?
- A. Subacute mastitis with early abscess formation.
- B. Advanced adenocarcinoma of the breast.
- C. Early intraduct carcinoma with obstruction of ductal ampullae.
- D. Severe fibrocystic disease of the breast (fibroadenosis with multiple cysts).
Correct Answer: B
Rationale: A non-painful breast lump in a 67-year-old is most likely advanced adenocarcinoma (B), a common malignancy in this age group. Mastitis (A) is painful, early carcinoma (C) less likely advanced, and fibrocystic disease (D) or fat necrosis (E) are less typical without specific trauma or cysts.
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A male patient diagnosed with paranoid schizophrenia typically relates effectively with female staff but angrily tells the male nurse, 'You act like a homosexual. None of the men trust you or want to be around you.' The nurse, who is heterosexual, is perplexed by the patient's statements and discusses the event with his mentor. Which explanation most likely underlies the patient's behavior?
- A. The patient was unleashing unconscious, hostile feelings toward the nurse.
- B. The patient feared the nurse would reject him, so he coped by rejecting the nurse first.
- C. It was the patient's way of distancing himself from potential emotional intimacy.
- D. The patient was coping with homosexual urges by projecting them onto the nurse.
Correct Answer: D
Rationale: The correct answer is D because the patient's accusation of the nurse being homosexual and implying that other men do not trust him or want to be around him suggests projection of the patient's own homosexual urges onto the nurse. This defense mechanism of projection helps the patient avoid acknowledging and dealing with his own uncomfortable feelings by attributing them to someone else.
Option A is incorrect because the patient's behavior is more about projecting feelings onto the nurse rather than unconscious hostility. Option B is incorrect as it focuses on the patient's fear of rejection rather than projecting his own feelings onto the nurse. Option C is incorrect as it does not address the specific dynamic of projecting homosexual urges onto the nurse.
A mother discusses her concerns about genetic transmission of schizophrenia with the nurse saying, 'My son is a fraternal twin. He has been diagnosed with schizophrenia. Will my other son develop schizophrenia, too?' The response that is both sensitive and shows understanding of the genetic component is:
- A. You poor woman! I wish I could tell you he will be free of the disorder.'
- B. Studies show that 50% of twins develop schizophrenia when it is present in the other twin.'
- C. No one can say what will happen, so we will hope for the best for you and your sons.'
- D. In fraternal twins, the chance of the other twin developing the disorder is quite small.'
Correct Answer: D
Rationale: The correct answer is D because it provides an accurate and sensitive response. Fraternal twins do not share the exact genetic makeup, so the chance of the other twin developing schizophrenia is lower compared to identical twins. This response acknowledges the genetic component of schizophrenia while also offering reassurance based on the understanding of genetic transmission.
Choices A and C are incorrect because they do not provide accurate information about the genetic risk of schizophrenia in fraternal twins and may not offer the mother a clear understanding of the situation. Choice B is incorrect as it provides a generalized statistic for identical twins, not fraternal twins, which could lead to unnecessary anxiety for the mother.
Inappropriate, life-threatening or challenging behaviours may be inadvertently maintained by reinforcement from others in the environment. Which of the following is a process that can be carried out in order to help identify the factors maintaining the behaviour?
- A. Functional analysis
- B. Statistical analysis
- C. Behavioural analysis
- D. Procedural analysis
Correct Answer: A
Rationale: Functional Analysis: Using operant conditioning principles to identify rewarding or reinforcing factors maintaining behavior.
Which of the following should the nurse use as a basis for explaining the etiology of Alzheimer's disease to the family of a client with this disease?
- A. It is a secondary dementia indicated by loss of recent memory and disorientation to time and place.
- B. It is a primary dementia that is incurable, irreversible, and fatal. It is caused by the presence of a beta-amyloid protein in the neurons resulting in senile plaques.
- C. It is a secondary dementia that is treatable with analysis of the diet and removal of toxic substances from the diet and environment.
- D. It is a primary dementia characterized by stepwise decreases in cognitive abilities. It is irreversible but treatable with antihypertensive medications.
Correct Answer: B
Rationale: The correct answer is B because Alzheimer's disease is a primary dementia that is characterized by the presence of beta-amyloid protein in neurons leading to the formation of senile plaques. This explanation is accurate as it describes the key pathological process underlying Alzheimer's disease.
Choice A is incorrect because Alzheimer's disease is a primary dementia, not a secondary dementia. Choice C is incorrect because the etiology of Alzheimer's disease is not related to diet or toxic substances, so it is not treatable in that way. Choice D is incorrect because while Alzheimer's disease is irreversible, it is not treatable with antihypertensive medications as these medications are not effective in managing the disease process of Alzheimer's.
A patient with the diagnosis of schizophrenia, disorganized type, approaches the nurse and says, "It's beat, it's eat. No room for doom." The nurse can correctly assess this verbalization as:
- A. Neologisms
- B. Clanging
- C. Ideas of reference.
- D. Associative looseness.
Correct Answer: B
Rationale: The correct answer is B: Clanging. Clanging refers to the association of words based on sound rather than meaning. In this case, the patient's verbalization "It's beat, it's eat. No room for doom" demonstrates a pattern of words that rhyme or have similar sounds but lack coherent meaning. This is characteristic of clanging seen in disorganized schizophrenia. Neologisms (A) are newly created words with unique meanings, which is not evident here. Ideas of reference (C) involve misinterpreting unrelated events as being personally significant, which is not demonstrated in the patient's statement. Associative looseness (D) is a thought disorder where ideas are loosely associated, but the patient's statement does not show this specific feature.