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A client with anorexia nervosa engages in manipulative behavior. She tells the nurse, 'I can't get weighed this morning, because I drank a glass of juice a few minutes before breakfast.' The best approach by the nurse would be:
- A. I'm pleased that you took in some calories.'
- B. We can get around this, if you'll eat a doughnut, too.'
- C. The rule is 'weigh before eating'; now we have to put it off until tomorrow.'
- D. This is weight day. Please step on the scale.'
Correct Answer: D
Rationale: Step 1: The correct answer is D because it sets clear boundaries and enforces consistency by reminding the client of the established protocol.
Step 2: By stating "This is weight day. Please step on the scale," the nurse maintains the structure and accountability in the treatment plan.
Step 3: This response avoids reinforcing manipulative behavior and emphasizes the importance of following the agreed-upon rules for accurate monitoring.
Step 4: Other choices like A may inadvertently validate the manipulation, B suggests giving in to the client's avoidance tactic, and C delays the weighing without addressing the manipulation directly.
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An 82-year-old widow with Alzheimer's disease lives with her daughter's family, which owns a catering business. During the week, the patient attends a daycare center for patients. During the evenings, members of the family care for the patient. One day, the nurse at the daycare center notices the patient's appearance is disheveled and that she has bruises on her wrists and back when escorted to the bathroom. What most likely explains the nurse's observations?
- A. The patient is being neglected and abused within the family.
- B. The dementia is progressing, reducing self-care and increasing falls.
- C. The patient is experiencing normal aging symptoms.
- D. The patient is suffering from a new medical condition.
Correct Answer: A
Rationale: The correct answer is A because the nurse's observations of disheveled appearance, bruises, and signs of physical abuse indicate possible neglect and abuse within the family. This is supported by the presence of Alzheimer's disease, vulnerability due to age, and the patient's living situation with family members who own a catering business. Choice B is incorrect as it does not explain the bruises and neglect observed. Choice C is incorrect as normal aging symptoms would not typically include bruises and neglect. Choice D is incorrect as there is no indication of a new medical condition causing these specific observations.
Behavioral problems in which the person exhibits symptoms suggesting physical disease or injury, but for which there is no identifiable cause, are called
- A. mood disorders
- B. schizophrenia
- C. organic brain pathologies
- D. somatoform disorders
Correct Answer: D
Rationale: Somatoform disorders feature physical complaints without medical explanation.
Schizophrenia in children as young as 5 years:
- A. Is a myth
- B. Can occur
- C. Never occurs
- D. Cannot occur
Correct Answer: B
Rationale: The correct answer is B: Can occur. Schizophrenia can indeed manifest in children as young as 5 years old, although it is rare. Symptoms may include hallucinations, delusions, disorganized speech, and impaired social interactions. Early diagnosis and intervention are crucial for managing the condition. Choice A is incorrect as schizophrenia in young children is not a myth. Choice C is incorrect as schizophrenia can occur in children. Choice D is incorrect as there have been documented cases of schizophrenia in children as young as 5 years old.
A 17-year-old patient with anorexia nervosa has just been released from the hospital. To facilitate recovery at home, the psychiatric-mental health nurse instructs the family to:
- A. discourage the patient from sneaking food between meals, by unobtrusively reducing access to the kitchen
- B. encourage the patient's interest in menu planning, food magazines, and cooking lessons, by leaving information and materials around the house
- C. permit the patient to eat her meals privately to discourage family preoccupation with meals
- D. recommend that the patient joins in routine family meals and clears the dishes after dinner, even if they do not eat
Correct Answer: D
Rationale: Involving the patient in family meals normalizes eating behavior and provides structure, supporting recovery without enabling secrecy or avoidance.
What is the most appropriate intervention for a patient with bulimia nervosa who is refusing to eat?
- A. Encourage the patient to eat small, frequent meals without pressure.
- B. Force the patient to eat larger meals to prevent further weight loss.
- C. Allow the patient to skip meals to avoid feeling overwhelmed.
- D. Focus only on addressing the patient's mental health concerns, not eating habits.
Correct Answer: A
Rationale: The correct answer is A because encouraging the patient to eat small, frequent meals without pressure promotes a balanced approach to eating. This intervention helps to establish a regular eating pattern and prevents episodes of binge-eating. It also respects the patient's autonomy and can help build trust between the patient and healthcare provider.
Choice B is incorrect because forcing the patient to eat larger meals can lead to increased anxiety and resistance, worsening the eating disorder. Choice C is incorrect as allowing the patient to skip meals can perpetuate unhealthy behaviors and reinforce the cycle of restriction and bingeing. Choice D is incorrect because neglecting the patient's eating habits can overlook a crucial aspect of their overall well-being and exacerbate the eating disorder.