Age Specific Care

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A client seen by the rape crisis nurse 1 month after the incident states, 'I'm confused and just not myself. I have mood swings during the day, and I have nightmares at night. Sometimes I think I'm going crazy.' Other times, she is just plain afraid to be alone. The nurse should assess the client for:

  • A. Trauma syndrome.
  • B. Post-traumatic stress disorder.
  • C. Acute stress disorder.
  • D. None of the above.
Correct Answer: A

Rationale: The correct answer is A: Trauma syndrome. This choice is correct because the client's symptoms of confusion, mood swings, nightmares, feeling like they are going crazy, and fear of being alone align with the criteria for trauma syndrome. This syndrome encompasses a range of symptoms that occur after experiencing a traumatic event, such as rape.

Choice B: Post-traumatic stress disorder (PTSD) is not the best option in this case because the client's symptoms are more indicative of acute distress and confusion rather than the criteria for a formal diagnosis of PTSD, which typically requires the persistence of symptoms over time.

Choice C: Acute stress disorder is also not the most appropriate choice because while some symptoms may align, the duration and specific criteria for this disorder may not fully match the client's presentation.

Choice D: None of the above is incorrect as trauma syndrome best fits the client's symptoms based on the information provided.

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Which nursing action should occur first regarding a patient who has a problem of sexual dysfunction or sexual disorder? The nurse should

  • A. develop an understanding of human sexual response.
  • B. assess the patient's sexual functioning and needs.
  • C. acquire knowledge of the patient's sexual roles.
  • D. clarify own personal values about sexuality.
Correct Answer: D

Rationale: The correct answer is D because clarifying the nurse's own personal values about sexuality is crucial before addressing a patient's sexual dysfunction. By understanding personal biases or judgments, the nurse can provide unbiased care. Assessing the patient's needs (B) should follow, as it directly addresses the patient's concerns. Developing an understanding of human sexual response (A) is important, but not as urgent as addressing personal values. Acquiring knowledge of the patient's sexual roles (C) is less relevant and should come after understanding the patient's needs.

Which of the following is a common complication of anorexia nervosa?

  • A. Hypertension and hyperglycemia.
  • B. Cardiovascular instability and electrolyte imbalances.
  • C. Insulin resistance and excessive weight gain.
  • D. Severe dehydration and frequent urination.
Correct Answer: B

Rationale: The correct answer is B: Cardiovascular instability and electrolyte imbalances. Anorexia nervosa can lead to severe malnutrition, causing cardiovascular issues like low heart rate and blood pressure. Electrolyte imbalances occur due to inadequate nutrient intake. Hypertension and hyperglycemia (choice A) are not common in anorexia. Insulin resistance and weight gain (choice C) are more associated with conditions like obesity. Severe dehydration and frequent urination (choice D) are not typical manifestations of anorexia.

In some countries, it is normal to defecate or urinate in public. This makes it clear that judgments of the normality of behavior are

  • A. culturally relative
  • B. statistical
  • C. a matter of subjective discomfort
  • D. related to conformity
Correct Answer: A

Rationale: Normality varies by culture, as behaviors acceptable in one society may be abnormal in another.

An advance directive gives legally binding direction for health care interventions when a patient:

  • A. has a new diagnosis of cancer
  • B. is diagnosed with Parkinsons disease
  • C. is unable to make decisions for self because of illness
  • D. diagnosed with amyotrophic lateral sclerosis is unable to speak
Correct Answer: C

Rationale: Advance directives are invoked when patients are unable to make their own health care decisions. The correct response is the most global answer. A diagnosis of cancer or Parkinsons disease does not mean the patient is unable to make a decision. For a patient with amyotrophic lateral sclerosis, there are other ways to communicate beyond speaking.

Which information would be important to incorporate when teaching about medications for dementia in a caregiver's support group? Select all that apply.

  • A. Antipsychotic medications have been shown to be the most useful category of drugs in reducing behavioral problems in dementias.
  • B. Most currently available medications slow the progress of the disease in 20% to 50% of patients but usually do not significantly improve functioning.
  • C. None of the currently available medications for dementias provide a cure.
  • D. None of the above.
Correct Answer: B

Rationale: The correct answer is B because it accurately conveys important information about medications for dementia to caregivers. It emphasizes that most medications do not significantly improve functioning but may slow disease progression in a subset of patients. This is crucial for setting realistic expectations.

Choice A is incorrect because antipsychotic medications are not the most useful category of drugs for reducing behavioral problems in dementia; they are associated with serious side effects and should be used cautiously.

Choice C is incorrect because it is essential for caregivers to understand that medications do not cure dementia; managing symptoms and slowing progression are the primary goals.

Choice D is incorrect as the correct answer is B, which provides valuable information for caregivers to understand the limitations and benefits of medications for dementia.

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