Population Specific Care

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A history reveals that a patient virtually stopped eating 5 months ago and lost 25% of body weight. The nurse says, "Describe what you think about your present weight and how you look." Which response would be most consistent with anorexia nervosa?

  • A. "I'm fat and ugly."
  • B. "What I think about myself is my business."
  • C. "I'm grossly underweight, but I cover it well."
  • D. "I'm a few pounds overweight, but I can live with it."
Correct Answer: A

Rationale: The correct answer is A because the response indicates a distorted body image, a common characteristic of anorexia nervosa. Anorexia nervosa is characterized by an intense fear of gaining weight and a distorted perception of body image, leading individuals to see themselves as overweight despite being underweight. In this case, the patient's response of "I'm fat and ugly" demonstrates a negative perception of their weight and appearance, which aligns with the distorted body image seen in anorexia nervosa.

Choices B, C, and D are incorrect:
B: "What I think about myself is my business" - This response does not indicate a distorted body image or negative perception of weight and appearance, which are key features of anorexia nervosa.
C: "I'm grossly underweight, but I cover it well" - While this response acknowledges being underweight, it does not reflect the distorted body image commonly seen in anorexia nervosa.
D: "I'm a

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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).

A 14-year-old client on the eating disorders unit refuses to eat her meals and says to the nurse on the unit, 'You can't make me eat! There is nothing wrong with me.' The nurse will assess this as use of which defense mechanism?

  • A. Repression.
  • B. Rationalization.
  • C. Sublimation.
  • D. Denial.
Correct Answer: D

Rationale: The correct answer is D: Denial. Denial is a defense mechanism where an individual refuses to acknowledge reality to avoid discomfort. In this scenario, the client is denying the seriousness of their situation by refusing to eat and claiming there is nothing wrong. Repression (A) involves unconsciously blocking out unpleasant thoughts or feelings. Rationalization (B) is creating logical explanations to justify behavior. Sublimation (C) is redirecting negative impulses into positive behaviors. In this case, denial is the most fitting defense mechanism as the client is refusing to accept the reality of their eating disorder.

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.

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.

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

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