Nokea
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.
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A patient referred to the eating disorders clinic lost 35 pounds over 3 months. To assess eating patterns, the nurse should ask:
- A. Do you often feel fat?
- B. Who plans the family meals?
- C. What do you eat in a typical day?
- D. What do you think about your present weight?
Correct Answer: C
Rationale: Rationale:
C is correct because it directly addresses the assessment of eating patterns by inquiring about the patient's actual food intake. This question provides valuable information on the quantity and quality of food consumed, aiding in diagnosing and treating eating disorders.
Other choices are incorrect:
A is focused on body image and self-perception, not eating patterns.
B is about family dynamics, not the patient's individual eating habits.
D pertains to body weight perception, not the specifics of the patient's diet.
An older adult patient was diagnosed with schizophrenia at age 18. A nurse at the outpatient medication clinic interviews this patient. Which communication strategy will be most helpful?
- A. Ask questions that can be answered with yes or no.
- B. Ask clear, simple questions using concrete language.
- C. Use silence often and let the patient take the lead.
- D. Use open-ended, indirect questions.
Correct Answer: B
Rationale: Communication with individuals who have schizophrenia might be difficult because of their various thought disorders. The nurse can be most effective by using simple language, keeping to concrete concepts, and clarifying and validating as needed (B). Yes/no questions (A) limit information, silence (C) may not engage, and open-ended questions (D) may confuse.
Which intervention would be most appropriate for a patient with bulimia nervosa who is at risk for electrolyte imbalance?
- A. Offer the patient water or an electrolyte replacement solution.
- B. Encourage the patient to engage in regular physical activity.
- C. Administer a diuretic as prescribed by the physician.
- D. Withhold food to reduce the risk of further weight gain.
Correct Answer: A
Rationale: The correct answer is A: Offering the patient water or an electrolyte replacement solution. This intervention is appropriate because patients with bulimia nervosa are at risk for electrolyte imbalances due to purging behaviors. Providing water or electrolyte replacement solution helps to replenish lost electrolytes and maintain proper balance.
Option B is incorrect as excessive physical activity can further deplete electrolytes. Option C is inappropriate as administering a diuretic can worsen electrolyte imbalances. Option D is also incorrect as withholding food can exacerbate the patient's condition and increase the risk of electrolyte imbalances.
A client with a borderline personality disorder tells the nurse, 'My doctor tells me there's something wrong with the hard wiring of my brain, and that's why I'm so impulsive and get so many mood swings. He said he's going to prescribe some medication.' Being aware of current practice guidelines, the nurse will prepare a teaching plan for:
- A. Lithium
- B. Fluoxetine
- C. Lorazepam
- D. Haloperidol
Correct Answer: B
Rationale: The correct answer is B: Fluoxetine. Borderline personality disorder (BPD) is primarily treated with psychotherapy, but in some cases, medication is used to manage symptoms like impulsivity and mood swings. Fluoxetine, a selective serotonin reuptake inhibitor (SSRI), is commonly used to address mood instability and impulsivity in BPD. SSRIs help regulate serotonin levels in the brain, which can improve mood stability and decrease impulsive behaviors. Lithium (choice A) is used for bipolar disorder, not BPD. Lorazepam (choice C) is a benzodiazepine used for anxiety and not typically recommended for BPD. Haloperidol (choice D) is an antipsychotic used for conditions like schizophrenia and not typically indicated for BPD.
False beliefs that are held even when the facts contradict them are called
- A. fantasies
- B. hallucinations
- C. illusions
- D. delusions
Correct Answer: D
Rationale: Delusions are fixed false beliefs resistant to contradictory evidence, unlike hallucinations (perceptions).