Nokea
A newly admitted patient diagnosed with paranoid schizophrenia is hypervigilant and constantly scans the environment. He states that he saw two doctors talking in the hall and knows they were plotting to kill him. When charting, how should the nurse identify this behavior?
- A. Idea of reference
- B. Delusion of infidelity
- C. Auditory hallucination
- D. Echolalia
Correct Answer: A
Rationale: The correct answer is A: Idea of reference. This term refers to the belief that neutral events are directed at oneself. In this case, the patient's interpretation of doctors talking as a plot against him signifies a misinterpretation of reality. Delusion of infidelity (B) involves belief in a partner's unfaithfulness, which is not applicable here. Auditory hallucination (C) involves hearing voices, not relevant to this scenario. Echolalia (D) is the repetition of words spoken by others, not demonstrated in the patient's behavior. Thus, A is the most appropriate identification for this behavior.
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A patient with borderline personality disorder cut her wrists while out on a pass. For future planning, staff should consider that the reason for the self-mutilation is probably related to:
- A. an inherited disorder that manifests itself as an incapacity to tolerate stress.
- B. fear of abandonment associated with relationships or increasing autonomy.
- C. use of projective identification and splitting to bring anxiety to manageable levels.
- D. a constitutional inability to regulate affect, predisposing to psychic disorganization.
Correct Answer: B
Rationale: Correct Answer: B
Rationale:
1. Borderline personality disorder is characterized by fear of abandonment.
2. Self-mutilation can be a maladaptive coping mechanism to alleviate this fear.
3. The behavior is often triggered by perceived threats to relationships or autonomy.
4. Therefore, considering fear of abandonment in future planning is crucial.
Summary of other choices:
A: Inherited disorder is not the primary reason for self-mutilation in borderline personality disorder.
C: Projective identification and splitting are defense mechanisms, not primary reasons for self-mutilation.
D: Constitutional inability to regulate affect may contribute, but fear of abandonment is more central in borderline personality disorder.
Which of the following procedures can be used to identify Down Syndrome pre-natally?
- A. Amniocentesis
- B. Amnioprolaxis
- C. Amniophalaxi
- D. Amniocalesis
Correct Answer: A
Rationale: Amniocentesis: A procedure extracting and analyzing amniotic fluid to identify Down Syndrome pre-natally in high-risk parents.
The mother of a 2-year-old tells the nurse at the well-child clinic that her child likes to take a blanket wherever he goes. The mother asks if she should take the blanket away from the child. The nurse counsels the mother to allow the child to have the blanket because it reminds him of his mother and comforts him. The basis for this counseling is:
- A. Mahler's theory of object relations
- B. Freud's developmental theory
- C. Kernberg's conceptualization object constancy
- D. Sullivan's theory of 'good me'
Correct Answer: A
Rationale: The correct answer is A: Mahler's theory of object relations. Mahler's theory focuses on the development of a child's sense of self and relationships. In the scenario provided, the child's attachment to the blanket can be seen as a transitional object, which is a source of comfort and security, similar to the mother. This concept aligns with Mahler's theory that objects like blankets can serve as symbols of the mother and aid in the child's emotional development.
Incorrect choices:
B: Freud's developmental theory primarily focuses on psychosexual stages of development, which do not directly address the use of transitional objects.
C: Kernberg's conceptualization of object constancy pertains to personality disorders and the ability to maintain stable relationships, not the use of transitional objects.
D: Sullivan's theory of 'good me' is centered around interpersonal relationships and self-esteem, which are not directly related to the use of transitional objects in early childhood development.
A novice nurse tells the assigned mentor, 'I admitted a patient today who has several bizarre delusions. I wanted to tell the patient that the ideas and conclusions simply are not logical. What do you think will happen if I do?' Which reply by the mentor is best?
- A. I think you'll give the patient something to think about.'
- B. The patient will probably incorporate you into the delusions as a persecutor.'
- C. Develop trust using empathy and calmness before pointing out discrepancies.'
- D. Initially, it would be better to go along with the patient's thinking to gain cooperation.'
Correct Answer: C
Rationale: The correct answer is C because it emphasizes the importance of developing trust and rapport with the patient before addressing their delusions. By using empathy and calmness, the nurse can create a safe environment for the patient to feel understood and supported. This approach can help the patient be more receptive to feedback about the discrepancies in their thinking.
Choice A is incorrect because simply giving the patient something to think about may not address the underlying issues causing the delusions.
Choice B is incorrect as it assumes the patient will view the nurse negatively, which may not always be the case.
Choice D is incorrect as it suggests going along with the patient's delusions, which can potentially reinforce and perpetuate their false beliefs.
A patient in the long-term phase of the rape-trauma syndrome had intrusive thoughts of the attack and developed fears of being alone. Which finding best demonstrates the patient has improved? The patient!
- A. Uses increased activity to reduce fear.
- B. Plans coping strategies for fearful situations.
- C. Temporarily withdraws from social situations.
- D. Expresses willingness to engage in sexual activity.
Correct Answer: B
Rationale: The correct answer is B because planning coping strategies for fearful situations indicates the patient is actively working on managing their fears and trauma, showing progress and improvement. Choice A is incorrect as increased activity may be a maladaptive coping mechanism. Choice C suggests social withdrawal, which is a sign of regression. Choice D may indicate premature attempts to engage in sexual activity without addressing the underlying trauma. Overall, choice B demonstrates proactive steps towards healing and recovery.