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A highly suspicious patient who has delusions of persecution about being poisoned has refused all hospital meals for 3 days. Which of the following interventions would be most appropriate under these circumstances?
- A. Feed the patient via tube, involuntarily via court order if needed.
- B. Offer to taste each food item on the tray yourself while he watches.
- C. Allow the patient to contact a local restaurant to deliver his meals.
- D. Allow him supervised access to use food vending machines in the hospital lobby.
Correct Answer: D
Rationale: Step 1: In this scenario, the patient is refusing hospital meals due to delusions of being poisoned, indicating a lack of trust.
Step 2: By allowing supervised access to food vending machines in the hospital lobby, the patient can choose his own food, promoting autonomy and trust-building.
Step 3: This intervention respects the patient's autonomy while ensuring access to food.
Step 4: In contrast, feeding via tube involuntarily (Option A) violates autonomy, tasting food yourself (Option B) doesn't address the issue of trust, and ordering from a restaurant (Option C) may not be feasible or safe in a hospital setting.
Summary: Option D is the most appropriate as it balances patient autonomy and safety, addressing the refusal of hospital meals effectively.
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Which complication should a nurse monitor for when treating a patient with bulimia nervosa who is experiencing frequent vomiting?
- A. Hypokalemia and dental enamel erosion.
- B. Hyperkalemia and elevated blood pressure.
- C. Severe dehydration and low blood sugar.
- D. Hypercalcemia and weight gain.
Correct Answer: A
Rationale: The correct answer is A: Hypokalemia and dental enamel erosion.
1. Bulimia nervosa involves frequent vomiting, leading to loss of potassium (hypokalemia) due to electrolyte imbalance.
2. Vomiting also damages tooth enamel, causing dental erosion.
3. Hyperkalemia and elevated blood pressure (choice B) are not typically associated with bulimia.
4. Severe dehydration and low blood sugar (choice C) are possible but not the primary concerns.
5. Hypercalcemia and weight gain (choice D) are not common complications of bulimia.
Which theme is most likely during family therapy with parents, siblings, and a teen patient with anorexia nervosa who engages in provocative behavior?
- A. Stable coalitions between family members
- B. Interpreting negative messages as positive
- C. Competition between the patient and father
- D. Lack of trust in the patient by family members
Correct Answer: C
Rationale: The correct answer is C: Competition between the patient and father. In family therapy with a teen patient with anorexia nervosa, the theme of competition between the patient and a parental figure, often the father, can be prominent. The rationale is that the father's influence and expectations can contribute to the teen's feelings of inadequacy and drive for control through anorexic behaviors. This dynamic can be explored and addressed in therapy to improve family relationships and support the patient's recovery.
A: Stable coalitions between family members - This is less likely as anorexia nervosa often disrupts family dynamics.
B: Interpreting negative messages as positive - While this can be a relevant theme, it is not as central to the specific scenario described.
D: Lack of trust in the patient by family members - While trust issues may exist, the theme of competition is more relevant in this context.
A patient with schizophrenia repeatedly asks for directions and the time of day. The nurse should:
- A. repeat the information in a kind, matter-of-fact manner.
- B. write out the information so the patient can easily refer to it.
- C. tell the patient that the habit of frequent questioning is annoying.
- D. provide the information once and then remind the patient that the question was already asked.
Correct Answer: A
Rationale: The correct answer is A because patients with schizophrenia may have cognitive impairments affecting memory and orientation, leading to repetitive questioning. By repeating information in a kind, matter-of-fact manner, the nurse can address the patient's needs without causing distress.
Choice B may be helpful, but verbal reinforcement is essential for immediate clarification. Choice C is incorrect as it may exacerbate the patient's distress and worsen the therapeutic relationship. Choice D does not address the underlying cognitive issue and may come across as dismissive.
Which symptom is most closely associated with the onset of anorexia nervosa?
- A. Excessive eating followed by purging.
- B. Obsession with calorie intake and extreme weight loss.
- C. Compulsive exercising to burn calories.
- D. Binge eating episodes with a lack of control.
Correct Answer: B
Rationale: The correct answer is B because an obsession with calorie intake and extreme weight loss is a hallmark symptom of anorexia nervosa. Individuals with anorexia nervosa typically have a distorted body image and an intense fear of gaining weight. This leads them to restrict their food intake severely, leading to extreme weight loss.
Choice A is incorrect because excessive eating followed by purging is more characteristic of bulimia nervosa, not anorexia nervosa. Choice C is incorrect as compulsive exercising is more commonly associated with another eating disorder called orthorexia nervosa. Choice D is incorrect as binge eating episodes with a lack of control are symptoms of binge eating disorder, not anorexia nervosa.
Vascular dementia is more common in individuals living in:
- A. The United States
- B. Japan
- C. France
- D. Australia
Correct Answer: B
Rationale: The correct answer is B: Japan. Vascular dementia is more common in countries with a high prevalence of risk factors such as hypertension, diabetes, and cardiovascular diseases. Japan has a high prevalence of these risk factors due to lifestyle factors and aging population. The other choices (A, C, D) do not have the same level of risk factors or population demographics as Japan, making them less likely to have a higher incidence of vascular dementia.