Nokea
A 76-year-old is regressed, indifferent, and responds to others only when they initiate an interaction. What form of group therapy would be most useful to promote resocialization?
- A. Remotivation
- B. Activity group
- C. Psychotherapy
- D. Reminiscence (life review)
Correct Answer: A
Rationale: Remotivation therapy helps to resocialize regressed and apathetic patients by focusing on a single topic, creating a bridge to reality as group members talk about the world in which they live and work and hobbies related to the topic. Group leaders give members acceptance and appreciation. Group psychotherapy would not be effective for this patient. An activity group does not address the patients problem.
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A patient is noted to be bending over backward in the group room. A peer asks what he is doing, and he replies, 'People say they are bending over backwards to help me, so I am bending over backwards to help myself.' This is an example of:
- A. abstract thinking.
- B. concrete thinking.
- C. impaired reality testing.
- D. boundary impairment.
Correct Answer: B
Rationale: The correct answer is B: concrete thinking. Concrete thinking refers to interpreting things in a literal or straightforward manner without grasping abstract concepts or metaphors. In this scenario, the patient is taking the expression "bending over backward" literally, demonstrating a lack of understanding of its figurative meaning.
A: Abstract thinking involves understanding complex concepts and interpreting information beyond the literal meaning. The patient's response does not demonstrate abstract thinking.
C: Impaired reality testing refers to an inability to distinguish between what is real and what is not. The patient's response does not suggest a detachment from reality.
D: Boundary impairment involves difficulty in recognizing and maintaining personal boundaries. The patient's response does not relate to boundary issues.
In summary, the patient's literal interpretation of the expression "bending over backward" reflects concrete thinking, making choice B the correct answer.
A 10-year-old boy presents with a history of central abdominal pain of a few hours' duration. On examination he has minimal tenderness in the right iliac fossa and no abnormal findings on rectal examination. Which of the following alternatives should be carried out?
- A. Arrange a barium meal follow through.
- B. Arrange to see the patient later on in the day for review.
- C. Send the patient away with instructions to return if the pain becomes worse.
- D. Tell the patient to come back in a week.
Correct Answer: B
Rationale: Early appendicitis can present subtly. Minimal right iliac fossa tenderness warrants observation, so reviewing later (B) is appropriate. Imaging (A), dismissal (C, D), or immediate surgery (E) without further assessment are not justified yet.
Which nursing progress note would most suggest that the treatment plan of a severely depressed and withdrawn patient has been effective?
- A. Slept 6 hours straight, sang with activity group, eager to see grandchild.
- B. Slept 8 hours, attended craft group, ate half of lunch, denies suicidal ideation.
- C. Slept 10 hours, personal hygiene adequate with assistance, lost one pound.
- D. Slept 7 hours on and off, reports "food has no taste", no self-harm noted.
Correct Answer: A
Rationale: The correct answer is A because it indicates positive changes in mood, engagement, and social interaction, which are key indicators of effective treatment for severe depression. Sleeping 6 hours straight shows improved sleep patterns, singing with the activity group reflects increased participation and enjoyment, and being eager to see the grandchild demonstrates a renewed sense of joy and connection.
Choice B is incorrect because although the patient denies suicidal ideation, the level of activity and engagement is not as high as in choice A. Choice C is incorrect as the focus is on physical aspects rather than emotional well-being and social interaction. Choice D is incorrect because the patient still shows signs of depression such as lack of appetite and loss of interest in activities.
What is a key consideration when treating a patient with anorexia nervosa?
- A. Addressing the patient's weight first and foremost.
- B. Focusing on nutrition and caloric intake without addressing underlying issues.
- C. Addressing the psychological and emotional factors that contribute to the disorder.
- D. Providing strict dietary restrictions to help the patient regain control over food.
Correct Answer: C
Rationale: The correct answer is C because addressing the psychological and emotional factors is crucial in treating anorexia nervosa. This disorder is not solely about weight or food intake; it often involves deeper psychological issues such as body image distortion, low self-esteem, and control issues. By focusing on the underlying psychological and emotional factors, therapists can help patients understand and cope with these issues, leading to more effective and sustainable recovery. Choices A, B, and D are incorrect because they overlook the complexity of anorexia nervosa and may even exacerbate the patient's condition by neglecting the root causes of the disorder.
When a victim of sexual assault is discharged from the emergency department, the nurse should:
- A. Notify the patient's family of the event to ensure support for the patient.
- B. Offer to stay with the patient until stability is regained.
- C. Advise the patient to try not to think about the assault.
- D. Provide referral information verbally and in writing.
Correct Answer: D
Rationale: The correct answer is D because providing referral information verbally and in writing ensures that the victim has access to appropriate resources for follow-up care and support. This step is crucial in helping the victim navigate the emotional and physical aftermath of the assault.
A: Notifying the patient's family without the patient's consent could violate the patient's privacy and autonomy.
B: While offering to stay with the patient shows support, it may not always be feasible and may not address the victim's long-term needs.
C: Advising the patient to try not to think about the assault is dismissive of their trauma and does not provide constructive support.