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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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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.
Impaired environmental interpretation syndrome related to metabolic disorders is a condition that affects how the body processes nutrients and energy.
- A. Impaired environmental interpretation related to metabolic disorders.
- B. Impaired environmental interpretation related to cognitive disorders.
- C. Impaired environmental interpretation related to sensory disorders.
- D. None of the above.
Correct Answer: A
Rationale: The correct answer is A because the term "environmental interpretation" refers to how the body processes external stimuli, which can be affected by metabolic disorders. Choice B is incorrect as cognitive disorders do not directly impact environmental interpretation. Choice C is incorrect as sensory disorders specifically affect sensory processing, not environmental interpretation. Choice D is incorrect as option A accurately reflects the relationship between impaired environmental interpretation and metabolic disorders.
A patient with an eating disorder states, 'I heard people laughing behind me in the check-out line at the department store. I bet they thought it was hysterically funny that I gained a pound in the last few days.' The nurse documents that the patient is exhibiting which cognitive distortion related to maladaptive eating regulation responses?
- A. Magnification
- B. Personalization
- C. Overgeneralization
- D. Dichotomous thinking
Correct Answer: B
Rationale: The correct answer is B: Personalization. Personalization is a cognitive distortion where an individual attributes external events to themselves without any evidence. In this case, the patient is assuming that people laughing were directed at them and related to their weight gain, which is a distorted belief.
A: Magnification involves blowing things out of proportion, which is not evident in this scenario.
C: Overgeneralization involves drawing broad conclusions based on a single incident, which is not happening here.
D: Dichotomous thinking involves seeing things in black and white terms, which is not demonstrated in the patient's statement.
In summary, the patient's attribution of others' laughter to their weight gain without evidence aligns with the cognitive distortion of personalization, making it the correct choice.
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.
A patient is referred to the visiting nurse agency due to cognitive impairment. Which functional problems is this patient most likely to exhibit?
- A. Inability to bathe and dress independently.
- B. Wandering in and away from his home.
- C. Lability of moods, from sociable to irritable.
- D. None of the above.
Correct Answer: A
Rationale: The correct answer is A: Inability to bathe and dress independently. Cognitive impairment can impact a person's ability to remember tasks and follow routines, resulting in difficulties with self-care activities like bathing and dressing. This is a common functional problem seen in patients with cognitive impairment.
Choice B (Wandering) is more indicative of behavioral symptoms like agitation and restlessness. Choice C (Mood lability) is related to emotional regulation and not directly related to functional problems caused by cognitive impairment. Choice D (None of the above) is incorrect as cognitive impairment often leads to difficulties with self-care tasks.