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A nurse assesses four patients between the ages of 70 and 80. Which patient has the highest risk for alcohol abuse? The patient who:
- A. consumes 1 glass of wine nightly with dinner
- B. began drinking alcohol daily after retirement and says, 'A few drinks keep my mind off my arthritis.'
- C. drank socially throughout adult life and continues this pattern, saying 'Ive earned the right to do as I please.'
- D. abused alcohol between the ages of 25 and 40 but now abstains and occasionally attends Alcoholics Anonymous (AA)
Correct Answer: B
Rationale: Alcohol abuse and dependence can develop at any age, and the geriatric population is particularly at risk. Losses, such as retirement, widowhood, and loneliness, are often related. The distracters describe patients with a lower risk for alcohol abuse.
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A patient with borderline personality disorder has been making steady progress but one day gets a phone call from her boyfriend, who breaks off their relationship. Although she has not self-injured in over 2 months, she makes repeated lacerations on her forearm. Which statement about this and most maladaptive behaviors seen in personality disorders is most accurate?
- A. People with personality disorders rarely achieve lasting improvement.
- B. However dysfunctional, most behavior is the person's best effort to cope.
- C. People with personality disorders are at the mercy of others' actions.
- D. What appears to be improvement can be manipulation instead.
Correct Answer: B
Rationale: The correct answer is B: However dysfunctional, most behavior is the person's best effort to cope. In this scenario, the patient's self-injury following the breakup is a maladaptive coping mechanism to deal with emotional distress. Individuals with personality disorders often engage in maladaptive behaviors as a way to cope with overwhelming emotions or stress. This behavior may not be effective or healthy, but it is their attempt to manage their internal struggles.
A: People with personality disorders rarely achieve lasting improvement - This statement is incorrect as individuals with personality disorders can make progress with therapy and support.
C: People with personality disorders are at the mercy of others' actions - This statement is incorrect as individuals with personality disorders have agency over their behaviors, even if they struggle with emotional regulation.
D: What appears to be improvement can be manipulation instead - This statement is incorrect as improvement in behavior should not be automatically attributed to manipulation; it could genuinely reflect progress in coping skills.
A severely withdrawn patient diagnosed with schizophrenia will spend time in the dayroom but will not speak to staff or to other patients. The most therapeutic nursing intervention in response to this behavior would be to:
- A. seat the patient with a group of patients who are talking to each other.
- B. ignore the silence and talk about superficial topics such as the weather.
- C. point out that the patient makes others uncomfortable by refusing to speak.
- D. plan time for staff members to sit with the patient even though the patient does not talk with them.
Correct Answer: D
Rationale: The correct answer is D because it focuses on building a therapeutic relationship with the patient without placing pressure on them to speak. By planning time for staff members to sit with the patient, even if the patient does not talk, it allows for nonverbal communication and presence to convey support and care. This approach respects the patient's boundaries and allows them to engage at their own pace, fostering trust and a sense of safety.
Choice A is incorrect as it may overwhelm the patient by placing them in a social situation they are not ready for. Choice B is incorrect as discussing superficial topics does not address the patient's underlying issues. Choice C is incorrect as it may make the patient feel judged or pressured to speak, further isolating them.
A person diagnosed with a serious mental illness (SMI) living in the community was punched, pushed to the ground, and robbed of 7 during the day on a public street. Which statements about violence and serious mental illness in general are accurate? Select one tha does not apply.
- A. Persons with SMI are more likely to be violent
- B. SMI persons experience higher rates of sexual assault and victimization than others
- C. Impaired judgment and social skills can provoke hostile or assaultive behavior
- D. Lower incomes force SMI persons to live in high-crime areas, increasing risk
Correct Answer: A
Rationale: Mentally ill persons are more likely to be victims of crime than perpetrators of criminal acts. They are often victims of criminal behavior, including sexual crimes, at a higher rate than others. When a mentally ill person commits a crime, it is usually nonviolent. Mental illnesses interfere with employment and are associated with poverty, limiting SMI persons to living in inexpensive areas that also tend to be higher-crime areas. SMI persons may inadvertently provoke others because of poor judgment or socially inappropriate behavior, or they may be victimized because they are perceived as passive, less likely to resist, and less likely to be believed as witnesses.
The early stage of Alzheimer's disease is characterized by:
- A. Loss of recent memory
- B. Loss of remote memory
- C. Withdrawal from family
- D. Apraxia
Correct Answer: A
Rationale: The correct answer is A: Loss of recent memory. In the early stage of Alzheimer's disease, individuals typically experience difficulty remembering recent events, conversations, or information. This is due to the initial impact of the disease on the hippocampus and other brain regions responsible for forming new memories. Choices B, C, and D are incorrect because loss of remote memory (choice B) usually occurs in later stages, withdrawal from family (choice C) can be a result of various factors beyond memory loss, and apraxia (choice D) refers to the inability to perform coordinated movements and is not a primary symptom of early-stage Alzheimer's.
The psychiatric-mental health nurse, who is teaching a patient's parents how to use positive reinforcement techniques with the patient, recommends:
- A. agreeing with the child's statements, whether negative or positive, and simply restating the child's statements without other comment
- B. controlling the child's behavior, so there is no chance of negative behavior
- C. removing adverse consequences to produce positive results
- D. rewarding positive behaviors to promote their recurrence
Correct Answer: D
Rationale: Positive reinforcement rewards desired behaviors, increasing their frequency, a core behavioral strategy.