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A client with an eating disorder tells the RN, "I’ve been eating only 400 calories per day and have been taking diuretics to lose weight.” What is the RN’s best response?
- A. “Your diet is very harmful and needs to be changed immediately.”
- B. “It’s important to monitor your calorie intake carefully.”
- C. “Have you noticed any physical effects from this low-calorie diet?”
- D. “The diuretics could be causing your body to lose essential nutrients.”
Correct Answer: D
Rationale: The correct response is D: “The diuretics could be causing your body to lose essential nutrients.” This response addresses both the client’s low-calorie diet and the use of diuretics, highlighting the potential harm caused by the diuretics in depleting essential nutrients from the body. By focusing on the specific issue of nutrient loss, the nurse can educate the client on the dangers of using diuretics for weight loss and encourage seeking professional help. Options A, B, and C do not address the potential harm of diuretics and may not adequately address the severity of the situation. Option C is more general and may not directly address the issue of nutrient loss.
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April, a 10-year-old admitted to inpatient pediatric care, has been getting more and more wound up and is losing self-control in the day room. Time-out does not appear to be an effective tool for April to engage in self-reflection. April’s mother admits to putting her in time-out up to 20 times a day. The nurse recognizes that:
- A. Time-out is an important part of April’s baseline discipline.
- B. Time-out is no longer an effective therapeutic measure.
- C. April enjoys time-out, and acts out to get some alone time.
- D. Time-out will need to be replaced with seclusion and restraint.
Correct Answer: B
Rationale: The correct answer is B: Time-out is no longer an effective therapeutic measure. In this scenario, April's escalating behavior and the ineffectiveness of time-out suggest that it is not addressing the underlying issues causing her behavior. Continuous use of time-out can lead to it losing its effectiveness and may not promote self-reflection. April's behavior worsening despite frequent use of time-out indicates the need for a different approach to address her needs.
Choices A, C, and D are incorrect because they do not address the situation at hand. Choice A assumes time-out is still effective despite evidence to the contrary. Choice C assumes April enjoys time-out, which is not supported by the information given. Choice D suggests a drastic and inappropriate measure of seclusion and restraint, which should only be used as a last resort in emergency situations.
Which therapeutic communication statement might a psychiatric-mental health registered nurse use when a patient’s nursing diagnosis is altered thought processes?
- A. I know you say you hear voices, but I cannot hear them.
- B. Stop listening to the voices, they are NOT real.
- C. You say you hear voices, what are they telling you?
- D. Please tell the voices to leave you alone for now.
Correct Answer: C
Rationale: The correct answer is C because it demonstrates active listening and encourages the patient to express their experiences. By asking "You say you hear voices, what are they telling you?" the nurse shows empathy, validation, and a non-judgmental attitude towards the patient's altered thought processes. This statement helps the patient feel heard and understood, fostering a therapeutic nurse-patient relationship.
Choice A is incorrect because it dismisses the patient's experience and does not acknowledge their reality. Choice B is incorrect as it commands the patient to stop listening to the voices without addressing the underlying issues. Choice D is incorrect because it suggests the patient has control over the voices, which may not be the case.
When patients diagnosed with schizophrenia suffer from anosognosia, they often refuse medication, believing that:
- A. Medications provided are ineffective.
- B. Nurses are trying to control their minds.
- C. The medications will make them sick.
- D. They are not actually ill.
Correct Answer: D
Rationale: The correct answer is D: They are not actually ill. Anosognosia is a symptom of schizophrenia where patients lack awareness of their illness. This leads them to deny their condition and refuse treatment. Choice A is incorrect as it assumes patients are aware of the medication's effectiveness. Choice B is incorrect as it introduces a paranoid belief not related to anosognosia. Choice C is incorrect as it focuses on physical side effects, not denial of illness.
A patient being treated for insomnia is prescribed ramelteon (Rozerem). Which comorbid mental health condition would make this medication the hypnotic of choice for this particular patient?
- A. Obsessive-compulsive disorder
- B. Generalized anxiety disorder
- C. Persistent depressive disorder
- D. Substance use disorder
Correct Answer: D
Rationale: The correct answer is D: Substance use disorder. Ramelteon is a melatonin receptor agonist used to treat insomnia by regulating the sleep-wake cycle without the risk of dependence or abuse, making it ideal for patients with substance use disorder. People with substance use disorder often have disrupted sleep patterns, and ramelteon can help improve their sleep without the risk of worsening their substance use disorder.
A: Obsessive-compulsive disorder - Ramelteon does not specifically target symptoms of OCD.
B: Generalized anxiety disorder - While insomnia can be a symptom of GAD, other medications may be more suitable for addressing anxiety symptoms.
C: Persistent depressive disorder - Ramelteon may not directly address depressive symptoms, and other medications may be more effective for PDD.
Overall, the unique pharmacological profile of ramelteon makes it an appropriate choice for patients with substance use disorder who also have insomnia.
What principle about nurse-patient communication should guide a nurse’s fear about “saying the wrong thing†to a patient?
- A. Patients tend to appreciate a well-meaning person who conveys genuine acceptance, respect, and concern for their situation.
- B. The patient is more interested in talking to you than listening to what you have to say and so is not likely to be offended.
- C. Considering the patient’s history, there is little chance that the comment will do any actual harm.
- D. Most people with a mentally illness have by necessity developed a high tolerance of forgiveness.
Correct Answer: A
Rationale: Correct Answer: A
Rationale: Effective nurse-patient communication is based on building trust, empathy, and understanding. Patients value sincerity, respect, and genuine concern from their healthcare providers. By conveying acceptance and respect, nurses can establish a positive rapport with patients, which is essential for effective communication. Patients are more likely to open up and trust a nurse who demonstrates empathy and understanding. This approach helps create a supportive environment for the patient to express their concerns and feel heard. Choices B, C, and D do not address the fundamental principles of building a therapeutic nurse-patient relationship through effective communication. Choice B assumes the patient is not likely to be offended, which may not always be the case. Choice C focuses on potential harm, which is not the primary concern in effective communication. Choice D makes a generalization about individuals with mental illness, which is not relevant to the principle of communication in nursing.