Nokea
A 79-year-old white male tells a nurse, 'I have felt very sad lately. I do not have much to live for. My family and friends are all dead, and my own health is failing.' The nurse should analyze this comment as:
- A. normal pessimism of the elderly
- B. evidence of risks for suicide
- C. a call for sympathy
- D. normal grieving
Correct Answer: B
Rationale: The patient describes loss of significant others, economic security, and health. He describes mood alteration and voices the thought that he has little to live for. Combined with his age, sex, and single status, each is a risk factor for suicide. Elderly white males have the highest risk for completed suicide.
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Which symptom is most closely associated with the onset of anorexia nervosa?
- A. Excessive eating followed by purging.
- B. Obsession with calorie intake and extreme weight loss.
- C. Compulsive exercising to burn calories.
- D. Binge eating episodes with a lack of control.
Correct Answer: B
Rationale: The correct answer is B because an obsession with calorie intake and extreme weight loss is a hallmark symptom of anorexia nervosa. Individuals with anorexia nervosa typically have a distorted body image and an intense fear of gaining weight. This leads them to restrict their food intake severely, leading to extreme weight loss.
Choice A is incorrect because excessive eating followed by purging is more characteristic of bulimia nervosa, not anorexia nervosa. Choice C is incorrect as compulsive exercising is more commonly associated with another eating disorder called orthorexia nervosa. Choice D is incorrect as binge eating episodes with a lack of control are symptoms of binge eating disorder, not anorexia nervosa.
Mood disorders are those in which the person may
- A. experience severe depression and threaten suicide
- B. exhibit symptoms suggesting physical disease or injury but for which there is no identifiable cause
- C. exhibit behavior that is the result of an organic brain pathology
- D. experience delusions and hallucinations
Correct Answer: A
Rationale: Mood disorders, like depression, feature extreme emotional states, including suicidal ideation.
It is a secondary dementia indicated by loss of recent memory and disorientation to time and place.
- A. Alzheimer's disease.
- B. Vascular dementia.
- C. Lewy body dementia.
- D. None of the above.
Correct Answer: A
Rationale: The correct answer is A: Alzheimer's disease. Alzheimer's disease is a common type of dementia characterized by progressive cognitive decline, including loss of recent memory and disorientation to time and place. This is due to the accumulation of amyloid plaques and neurofibrillary tangles in the brain. Vascular dementia (B) is caused by reduced blood flow to the brain, leading to cognitive impairment. Lewy body dementia (C) is characterized by the presence of abnormal protein deposits called Lewy bodies in the brain. Choosing D (None of the above) would be incorrect as Alzheimer's disease specifically matches the description provided in the question.
Confidentiality should be discussed with all adolescents and parents before the consult. Confidentiality may be breached in all situations below EXCEPT:
- A. Disclosure of sexual abuse
- B. Disclosure of drug abuse
- C. Disclosure of suicidality
- D. Disclosure of dropping grades
Correct Answer: D
Rationale: Confidentiality can be breached for safety concerns (abuse, drug use, suicidality), but dropping grades is not a direct threat to safety or health, so it does not warrant breaching confidentiality.
Which situation would be most likely to serve as a trigger to a catastrophic reaction in a client with stage 2 Alzheimer's disease?
- A. Participating in singing 'Happy Birthday' to another client at dinner
- B. Being scolded by an aide for spilling a glass of milk
- C. Listening to Big Band music from the 1940s
- D. Eating cupcakes in the activities room
Correct Answer: B
Rationale: The correct answer is B because being scolded for spilling milk can trigger feelings of shame, embarrassment, and confusion in a person with Alzheimer's stage 2. This negative interaction can lead to heightened agitation, aggression, or emotional distress due to the client's impaired ability to process and regulate emotions. In contrast, choices A, C, and D involve positive or neutral activities that are less likely to evoke such strong negative emotions or reactions in someone with Alzheimer's disease.