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A homeless individual diagnosed with serious mental illness, anosognosia, and a history of persistent treatment nonadherence is persuaded to come to the day program at a community mental health center. Which intervention should be the teams initial focus?
- A. Teach appropriate health maintenance and prevention practices.
- B. Educate the patient about the importance of treatment adherence.
- C. Help the patient obtain employment in a local sheltered workshop.
- D. Interact regularly and supportively without trying to change the patient.
Correct Answer: D
Rationale: Building trust through regular, supportive interaction (D) is the initial focus to address nonadherence and anosognosia, forming a foundation for later interventions (A, B, C).
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Which neighborhood in Boston had the highest rates of Chlamydia in 2006?
- A. Allston/Brighton
- B. Roxbury
- C. Jamiaca Plain
- D. Roslindale
Correct Answer: B
Rationale: Roxbury, a historically underserved area, had higher Chlamydia rates in 2006, likely due to socioeconomic factors and limited healthcare access.
A client who has been diagnosed as having bulimia nervosa is hospitalized for treatment of electrolyte imbalance. Just before lunch is finished, the client leaves the table and walks quickly in the direction of the bathroom. The nurse should say:
- A. No one is allowed to leave the dining room during meals.'
- B. I must accompany you when you go to the bathroom.'
- C. I think I understand your plan, and I cannot permit you to carry it out.'
- D. Wouldn't it be preferable to exercise rather than vomit?'
Correct Answer: B
Rationale: The correct answer is B because accompanying the client to the bathroom is essential to prevent purging behavior associated with bulimia nervosa. By doing so, the nurse can provide support, monitor the client, and intervene if necessary to ensure the client's safety. Choice A is incorrect as it may come across as punitive and restrictive. Choice C is incorrect as it may escalate the situation and lead to confrontation. Choice D is incorrect as it suggests an alternative behavior without addressing the immediate concern of potential purging. Accompanying the client to the bathroom is the most appropriate and therapeutic response in this situation.
A psychiatric clinical nurse specialist uses cognitive therapy with a patient with anorexia nervosa. Which statement by the nurse supports this type of therapy?
- A. What are your feelings about not eating foods you prepare?
- B. You seem to feel much better about yourself when you eat something.
- C. It must be difficult to talk about private matters to someone you just met.
- D. Being thin doesn't seem to solve problems. You're thin now but still unhappy.
Correct Answer: D
Rationale: The correct answer is D because it reflects a key principle of cognitive therapy, which is challenging distorted thoughts and beliefs. In this statement, the nurse is helping the patient recognize that being thin has not resolved their underlying unhappiness. This challenges the patient's belief that thinness equals happiness, promoting insight and cognitive restructuring.
A: This statement focuses on emotions related to food and preparation, not directly challenging distorted thoughts.
B: This statement focuses on self-esteem related to eating, not directly challenging distorted thoughts.
C: This statement addresses the difficulty of sharing personal information, not directly challenging distorted thoughts.
The nurse in the emergency department tells the daughter of a patient that her 86-year-old mother has had a stroke. The daughter tearfully asks the nurse, 'Who will take care of me now?' When the nurse explores this query, the daughter mentions that her mother always tells her what job to take, what clothes to buy and wear, and what to have for lunch. The daughter states that she needs someone to direct her and reassure her when she gets anxious. With which personality disorder is this presentation most consistent?
- A. Histrionic
- B. Dependent
- C. Narcissistic
- D. Borderline
Correct Answer: B
Rationale: The correct answer is B: Dependent. This presentation is most consistent with dependent personality disorder because the daughter is displaying excessive need for someone to take care of her and make decisions for her, as well as seeking reassurance and guidance when anxious. Individuals with dependent personality disorder often lack self-confidence and rely heavily on others for emotional and physical needs.
Choice A: Histrionic personality disorder is characterized by attention-seeking behavior and excessive emotions, which do not match the daughter's presentation.
Choice C: Narcissistic personality disorder involves a grandiose sense of self-importance and a lack of empathy for others, which is not evident in the daughter's behavior.
Choice D: Borderline personality disorder is characterized by unstable relationships, self-image, and emotions, as well as impulsive behaviors, which are not reflected in the daughter's need for constant direction and reassurance.
Which statement by a patient with anorexia nervosa indicates a need for further education?
- A. I understand that my weight loss is dangerous, and I want to regain weight.
- B. I feel good about my body and don't need to gain weight.
- C. I am willing to work with my healthcare team to restore my nutrition.
- D. I know I need to eat more to improve my health.
Correct Answer: B
Rationale: The correct answer is B because feeling good about their body and not recognizing the need to gain weight is a common symptom of anorexia nervosa. This statement indicates a lack of insight into the seriousness of their condition and the necessity to restore a healthy weight. The other choices (A, C, D) demonstrate an understanding of the importance of weight gain, collaboration with healthcare professionals, and the need for increased food intake to improve health, indicating a willingness to engage in treatment and recovery.