Concept of Family Health Nursing Care

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A hospitalized patient, injured in a fall while intoxicated, believes spiders are spinning entrapping webs in the room. The patient is anxious, agitated, and diaphoretic. Which nursing intervention has priority?

  • A. Check the patient every 15 minutes.
  • B. Rigorously encourage fluid intake.
  • C. Provide one-on-one supervision.
  • D. Keep the room dimly lit.
Correct Answer: C

Rationale: The correct answer is C: Provide one-on-one supervision. This intervention has priority because the patient is experiencing hallucinations, agitation, and anxiety, which can pose a risk to their safety. One-on-one supervision ensures constant monitoring and immediate intervention if the patient's condition deteriorates. Checking the patient every 15 minutes (A) may not provide timely intervention. Encouraging fluid intake (B) is important but not the priority in this situation. Keeping the room dimly lit (D) may not address the patient's hallucinations and agitation adequately.

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Select the most appropriate outcome for a patient completing the fourth alcohol detoxification program in 1 year. Before discharge, the patient will

  • A. use rationalization in healthy ways.
  • B. state, 'I see the need for ongoing treatment.'
  • C. identify constructive outlets for expression of anger.
  • D. develop a trusting relationship with one staff member.
Correct Answer: B

Rationale: The correct answer is B because stating 'I see the need for ongoing treatment' demonstrates insight and willingness to engage in further treatment, indicating a readiness for change. This is crucial for someone who has completed multiple detox programs in a short period. Choice A (using rationalization in healthy ways) may not address the underlying issues leading to repeated detox programs. Choice C (identifying constructive outlets for expression of anger) is important but not the most urgent concern after detox. Choice D (developing a trusting relationship with one staff member) is beneficial but does not address the need for ongoing treatment.

Semantic memory is the type of-----:

  • A. Episodic memory
  • B. Short term memory
  • C. Explicit memory
  • D. Cognitive memory
Correct Answer: C

Rationale: Semantic memory, storing general knowledge, is a form of explicit (conscious) memory, per Tulving.

Which of the following is common among indigent, rural Appalachian patients?

  • A. Perceived socioeconomic discrimination
  • B. Lack of knowledge about preventive health care
  • C. Sexually transmitted infections
  • D. Willingness to adhere to prescribed medications
Correct Answer: A

Rationale: Perceived discrimination is prevalent due to socioeconomic disparities.

Psychologicalization of illness' is best defined by which of following statements?

  • A. Redefinition of illness as an intangible process
  • B. Examination of the effects of physical illness on a patient's mental capacity
  • C. The stress response to acute illness
  • D. Overemphasis on psychological factors without just evidence
Correct Answer: D

Rationale: Psychologicalization overattributes symptoms to mental causes without evidence.

A nurse is called to the home of a neighbor and finds an unconscious person still holding a medication bottle labeled pentobarbital sodium. What is the nurse’s first action?

  • A. Test reflexes
  • B. Check pupils
  • C. Initiate vomiting
  • D. Establish a patent airway
Correct Answer: D

Rationale: The correct answer is D: Establish a patent airway. The first action in any emergency situation involving an unconscious person is to ensure their airway is open and clear to facilitate breathing. This is crucial for maintaining oxygenation and preventing potential complications like hypoxia. Testing reflexes (A) and checking pupils (B) are important assessments but not the immediate priority in this situation. Initiating vomiting (C) is contraindicated as it can lead to further complications, especially if the person has ingested a potentially harmful substance.

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