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A new client admits to having been battered by her live-in boyfriend several times over the past 2 years. She states to the nurse, 'We plan to get married next June, and I think things will be better then. He is always so sorry afterward, that I think I can trust him to change.' Which intervention should be included in the client's teaching plan?

  • A. Support her hope that the battering will end after they are married.
  • B. Assist her to enroll in a class to learn techniques of self-defense.
  • C. Emphasize that the battering pattern usually remains the same in frequency and severity over time.
  • D. Assist her in developing an emergency plan, since the pattern of violence is likely to continue.
Correct Answer: D

Rationale: The correct answer is D: Assist her in developing an emergency plan, since the pattern of violence is likely to continue. This choice is correct because it focuses on safety planning, which is crucial for individuals in abusive relationships. By helping the client develop an emergency plan, the nurse is acknowledging the seriousness of the situation and providing practical strategies to ensure her safety. It is important to have a plan in place in case of future violence.

Explanation for the incorrect choices:
A: Supporting her hope that the battering will end after they are married is not appropriate as it may give false hope and does not address the immediate safety concerns.
B: Enrolling in a self-defense class may not be effective in situations of domestic violence as it can escalate the violence and may not address the underlying issues causing the abuse.
C: Emphasizing that the battering pattern usually remains the same in frequency and severity over time is not as helpful as developing a concrete safety plan to address the immediate danger.

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For patients diagnosed with serious mental illness, what is the major advantage of case management?

  • A. The case manager can modify traditional psychotherapy
  • B. With one coordinator of services, resources can be more efficiently used
  • C. The case manager can focus on social skills training and esteem building
  • D. Case managers bring groups of patients together to discuss common problems
Correct Answer: B

Rationale: The case manager coordinates the care and multiple referrals that so often confuse the seriously mentally ill patient and the patients family. Case management promotes efficient use of services. The other options are lesser advantages or are irrelevant.

A client diagnosed with Alzheimer's disease has a catastrophic reaction during an activity involving simultaneous playing of music and working on a craft project. The client starts shouting 'no, no, no' and rushes out of the room. The nurse should:

  • A. Isolate the client until she is calm, and then direct her back to the activity
  • B. Follow the client, reassure her, and redirect her to a quieter activity
  • C. Discontinue the activity program since it upsets the clients
  • D. Give the client pm antianxiety medication and restrict her activity participation
Correct Answer: B

Rationale: The correct answer is B. The nurse should follow the client, reassure her, and redirect her to a quieter activity. This approach acknowledges the client's feelings and provides support to help her calm down. Isolating the client (Choice A) may escalate the situation and not address the underlying cause of the reaction. Discontinuing the activity program (Choice C) is not the best option as it may limit the client's engagement and therapeutic benefits. Giving medication and restricting activity (Choice D) should be a last resort and not the initial response to a behavioral reaction. In summary, Choice B focuses on comforting and redirecting the client, promoting a positive and supportive environment.

The nurse is working with a patient diagnosed with bulimia nervosa. Which assessment is most important?

  • A. Monitor electrolyte levels and cardiac function.
  • B. Observe for compulsive eating behaviors.
  • C. Track the patient's ability to self-regulate food intake.
  • D. Assess for symptoms of depression and anxiety.
Correct Answer: A

Rationale: The correct answer is A because patients with bulimia nervosa are at risk for electrolyte imbalances and cardiac issues due to purging behaviors. Monitoring electrolyte levels and cardiac function is crucial for early detection and intervention. Option B is incorrect as it focuses on behaviors rather than potential medical complications. Option C is less critical than monitoring electrolytes and cardiac function. Option D, although important, is not as immediately critical as monitoring electrolyte levels and cardiac function in this context.

A physical therapist recently convicted of multiple counts of Medicare fraud is brought to the emergency department after taking an overdose of sedatives. He tells the nurse, 'Sure I overbilled. Why not? Everybody takes advantage of the government. They have too many rules. No one can abide by all of them.' These statements can be assessed as showing:

  • A. glibness and charm.
  • B. superficial remorse.
  • C. lack of guilt feelings.
  • D. excessive suspiciousness.
Correct Answer: C

Rationale: The correct answer is C: lack of guilt feelings. The physical therapist's statements reveal a lack of remorse or guilt for committing Medicare fraud, indicating a disregard for ethical standards and a lack of moral responsibility. This behavior is indicative of a lack of guilt feelings, as the individual shows no remorse for their actions.

Summary of other choices:
A: Glibness and charm typically involve smooth talking and being persuasive, which is not demonstrated in the scenario.
B: Superficial remorse implies a shallow or insincere apology, but the individual does not express any form of remorse in this situation.
D: Excessive suspiciousness refers to being overly mistrustful or paranoid, which is not evident in the physical therapist's statements.

Which symptom reported by a client, age 35, who was sexually abused as a child reflects the diagnosis of posttraumatic stress disorder (PTSD)?

  • A. Reexperiencing the traumatic event
  • B. Refusing to go to public places from which escape may be difficult
  • C. Seeking advice and guidance prior to making any significant decision
  • D. Ruminating over the abuse with friends and acquaintances
Correct Answer: A

Rationale: The correct answer is A: Reexperiencing the traumatic event. This symptom is a key criterion for diagnosing PTSD according to the DSM-5. It includes flashbacks, nightmares, or intrusive thoughts related to the traumatic event. This symptom indicates that the client is experiencing distressing memories of the past abuse, which is a common feature of PTSD.

Choice B is incorrect because it describes agoraphobia, a separate anxiety disorder, not specific to PTSD. Choice C is incorrect as seeking advice is not a diagnostic criterion for PTSD. Choice D is incorrect because ruminating over the abuse with others may reflect coping mechanisms or seeking support, but it does not necessarily indicate PTSD.

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