Nokea
A client with a diagnosis of Schizophrenia has been released from an acute care setting. The client had a prolonged recovery from relapse. One of the parents says to the discharge nurse, 'I do not understand what is going on. The hospital said she was better, but all she does is sit around all day and smoke. We cannot get her to go to the vocational training you arranged.' The nurse recognizes that more teaching is needed about:
- A. the pathophysiology and acting out behaviors of schizophrenia.
- B. support groups that can help the parents release their feelings of frustration.
- C. the prolonged recovery time and depressive effects of medicines to prevent relapse.
- D. motivational techniques that are effective in clients with schizophrenia.
Correct Answer: C
Rationale: The nurse conducting discharge teaching must stress the lengthy recuperation process with emphasis on the sedative qualities of the medication used to prevent relapse. Support groups are useful for caregivers. The emphasis during recuperation is on maintaining nutrition and hygiene.
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Two staff nurses were considered for promotion to head nurse. The promotion is announced via a memo on the unit bulletin board. The nurse who was not promoted tells a friend, 'Oh, well, I really didn't want the job anyway.' This is an example of:
- A. rationalization.
- B. denial.
- C. projection.
- D. compensation.
Correct Answer: A
Rationale: This is called the sour grapes form of rationalization. Rationalization is an unconscious form of self-deception in which excuses are made.
Elderly persons with pernicious anemia should be instructed:
- A. to increase their dietary intake of foods high in B12.
- B. that they do not need to return for follow-up for at least a month after initiation of treatment.
- C. that oral B12 is safer and less expensive than parenteral replacement.
- D. that diarrhea can be a transient side effect of B12 injections.
Correct Answer: D
Rationale: Pernicious anemia is a megaloblastic, macrocytic, normochronic anemia caused by a deficiency of the intrinsic factor produced by the stomach. This results in malabsorption of vitamin B12, which is necessary for DNA synthesis and maturation of RBC. Education should include side effects of Vitamin B12, which can include pain and burning at the injection site, peripheral vascular thrombosis, and transient diarrhea.
An 8-year-old Asian child is being examined during a school screening. The nurse notices small bruises on the anterior and posterior ribs. The nurse should ask the child:
- A. If the family practices coining
- B. Who hit him
- C. If the child has fallen
- D. How long the abuse has been occurring
Correct Answer: A
Rationale: Coining, a cultural practice in some Asian communities, can cause bruising and should be assessed to differentiate from abuse. Other options assume abuse prematurely.
With a breech presentation, the nurse must be particularly alert for which of the following?
- A. quickening
- B. ophthalmia neonatorum
- C. pica
- D. prolapsed umbilical cord
Correct Answer: D
Rationale: Prolapsed umbilical cord is the descent of the umbilical cord into the vagina before the fetal presenting part and compression of the cord between the presenting part and the maternal pelvis, compromising or completely cutting off fetoplacental perfusion. This is an emergency situation; immediate delivery should be attempted to save the fetus.
Appropriate nursing strategies to assist a client in maintaining a sense of self include:
- A. using the client's first name when addressing the client
- B. treating the client with dignity
- C. explaining procedures only if the client is attentive
- D. discouraging the use of personal items
Correct Answer: B
Rationale: Treating the client with dignity respects their individuality and fosters a sense of self, unlike the other options, which may undermine autonomy or engagement.