Population Specific Care

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A client with anorexia nervosa has refused meal trays and supplemental feedings for 3 days following admission to the general hospital. The nurse can anticipate that intervention will include:

  • A. IV infusions beginning immediately and continuing for 48 hours after client begins eating.
  • B. Tube feedings until the client eats 90% of all meals for 1 day.
  • C. Placing the client on suicide precautions and one-to-one observation.
  • D. Limiting peer group visitors for 2 weeks.
Correct Answer: B

Rationale: The correct answer is B. Tube feedings until the client eats 90% of all meals for 1 day. This intervention is appropriate for a client with anorexia nervosa who is refusing to eat. Tube feedings ensure adequate nutrition while also encouraging the client to resume eating orally. It is a gradual approach that aims to transition the client back to regular eating habits.

Explanation for why other choices are incorrect:
A: IV infusions are not the first-line intervention for a client with anorexia nervosa refusing to eat. This choice does not address the underlying issue of the client's refusal to eat.
C: Placing the client on suicide precautions and one-to-one observation is not indicated solely based on refusal to eat. This choice does not address the nutritional needs of the client.
D: Limiting peer group visitors for 2 weeks does not address the client's refusal to eat and is not a relevant intervention in this situation.

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Which patient is at greatest risk for physical abuse by a family member?

  • A. An 8-year-old who is mentally challenged and living with a foster family
  • B. A 15-year-old who lives with a single parent in an inner city apartment complex
  • C. A 30-year-old adult who shares a home with a homosexual partner
  • D. A 79-year-old with chronic depression who lives with a grandchild
Correct Answer: D

Rationale: The correct answer is D because the 79-year-old with chronic depression who lives with a grandchild is vulnerable due to age, health condition, and dependency on the grandchild. Older adults with mental health issues are at a higher risk of abuse, especially when living with family members. The other choices are less likely to be at greatest risk for physical abuse. A, B, and C do not have the same level of vulnerability due to age, health condition, or dependency as the 79-year-old with chronic depression living with a grandchild.

An adult diagnosed with a serious mental illness says, I do not need help with money management. I have excellent ideas about investments. This patient usually does not have money to buy groceries by the middle of the month. The nurse assesses the patient as demonstrating:

  • A. rationalization.
  • B. identification.
  • C. anosognosia.
  • D. projection.
Correct Answer: C

Rationale: The patient shows anosognosia (C), an inability to recognize deficits due to illness, believing in their financial acumen despite evidence. This isn't rationalization (A), identification (B), or projection (D).

The dopamine-psychosis link is based on the observation that

  • A. low dopamine levels of activity in the brain seem to produce psychotic symptoms
  • B. there are high levels of dopamine activity in the brains of psychotic people
  • C. there are high levels of amphetamine in the brains of schizophrenics
  • D. dopamine interacts with serotonin creating psychosis
Correct Answer: B

Rationale: Elevated dopamine activity is associated with psychotic symptoms, especially in schizophrenia.

A patient with schizophrenia is admitted to the psychiatric unit in an acutely disturbed, violent state. He is given several doses of haloperidol (Haldol) and becomes calm and approachable. During rounds the nurse notices the patient has his head rotated to one side in a stiffly fixed position. His lower jaw is thrust forward and he appears severely anxious. The patient has _____, and the nurse should _____.

  • A. A dystonic reaction"¦administer PRN IM benztropine (Cogentin)
  • B. Tardive dyskinesia"¦seek a change in the drug or its dosage
  • C. Waxy flexibility"¦continue treatment with antipsychotic drugs
  • D. Akathisia"¦administer PRN diphenhydramine (Benadryl) PO
Correct Answer: A

Rationale: The correct answer is A: A dystonic reaction"¦administer PRN IM benztropine (Cogentin). This patient is exhibiting symptoms of acute dystonia, a extrapyramidal side effect of haloperidol. Dystonic reactions are characterized by sustained muscle contractions causing abnormal postures. Benztropine is an anticholinergic medication that helps alleviate these symptoms by blocking the neurotransmitter acetylcholine. Administering benztropine is the appropriate treatment for acute dystonia.

Summary of other choices:
B: Tardive dyskinesia"¦seek a change in the drug or its dosage - Tardive dyskinesia is a side effect that occurs after long-term antipsychotic use, not acutely like in this case.
C: Waxy flexibility"¦continue treatment with antipsychotic drugs - Waxy flexibility is a symptom of catatonia, not a side effect of antipsychotic medications

A client is admitted to a day hospital following an episode in which he purchased a gun to use while standing guard over his property to prevent a neighbor from erecting a boundary fence. His wife describes him as distrustful of the motives of others and often interpreting others' motives as threats. She mentions that one time he accused her of having an affair with a neighbor with whom she chatted occasionally. The care plan will list the priority outcome as 'Client will:

  • A. admit his action was excessive based on the circumstance.
  • B. write the neighbor a letter of apology.
  • C. demonstrate trust in the nurse.
  • D. identify positive role models.'
Correct Answer: C

Rationale: The correct answer is C: demonstrate trust in the nurse. This is the priority outcome because the client's lack of trust and tendency to perceive threats need to be addressed first. By demonstrating trust in the nurse, the client can begin to develop a therapeutic relationship, which is essential for addressing his distrustful behavior and interpreting threats. This outcome focuses on building rapport and establishing a foundation for therapeutic interventions.

Choice A is incorrect because admitting his action was excessive may not address the underlying issues of distrust and misinterpretation of motives. Choice B is incorrect as it does not address the client's core issues and may not be appropriate in this context. Choice D is also incorrect as identifying positive role models is not a priority when the client's trust and perception issues need immediate attention.

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