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A nurse assesses that which of the following individuals is most likely to engage in binge-eating behaviors characteristic of bulimia?
- A. A person who weighs 225 pounds and is 5 feet 4 inches tall.
- B. A person who is 5 pounds overweight and cannot stick to a diet.
- C. A person who lost up 40 pounds but gained it back within 1 year.
- D. A person who monitors caloric intake in order to fit into a small suit.
Correct Answer: B
Rationale: The correct answer is B because binge-eating behaviors are often associated with individuals who struggle to control their eating, leading to episodes of excessive food consumption. Being unable to stick to a diet indicates a lack of control, which is a key characteristic of binge-eating. Choice A focuses more on weight and height, which are not direct indicators of binge-eating. Choice C describes weight fluctuations, which may not necessarily be linked to binge-eating. Choice D emphasizes monitoring caloric intake for a specific goal, which does not necessarily indicate a loss of control over eating behavior.
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A person diagnosed with serious mental illness has frequent relapses, usually precipitated by situational stressors such as running out of money or the absence of key staff at the mental health center. Which interventions would the nurse suggest to reduce the risk of stressors to cause relapse? Select one tha does not apply.
- A. Discourage potentially stressful activities such as groups or volunteer work
- B. Develop written plans that will help the patient remember what to do in a crisis
- C. Help the patient identify and anticipate events that are likely to be overwhelming
- D. Encourage health-promoting activities such as exercise and getting adequate rest
Correct Answer: A
Rationale: Basic interventions for coping with crises involve anticipating crises where possible and then developing a plan with specific actions to take when faced with an overwhelming stressor. Written plans are helpful; it can be difficult for anyone, especially a person with cognitive or memory impairments, to develop or remember steps to take when under overwhelming stress. Health-promoting activities enhance a persons ability to cope with stress. As the name suggests, support groups help a person develop a support system, and they provide practical guidance from peers who learned from experience how to deal with issues the patient may be facing. Groups and volunteer work may involve a measure of stress but also provide benefits that help persons cope and should not be discouraged unless they are being done to excess.
A patient who has been hospitalized for 2 days remains delusional and anxious and does not yet appear to be ready to give up the delusions. What intervention will best help the patient focus less on the delusion?
- A. Schedule time for the patient to read and listen to music.
- B. Plan activities that require physical skills and constructive use of time.
- C. Begin planning for discharge by engaging the patient in psychoeducation.
- D. Discuss personal goals related to improved socialization with the patient.
Correct Answer: B
Rationale: The correct answer is B because engaging in activities that require physical skills and constructive use of time can help the patient shift their focus away from the delusions. Physical activities can help reduce anxiety and provide a sense of accomplishment, which can help distract the patient from the delusions. It also promotes a sense of normalcy and routine, which can aid in grounding the patient in reality.
Choice A is incorrect because reading and listening to music may not actively engage the patient in a way that helps them shift their focus from the delusions. Choice C is incorrect because planning for discharge may be premature and may not address the immediate need to distract the patient from the delusions. Choice D is incorrect because discussing personal goals related to improved socialization may not be effective in helping the patient focus less on the delusions at this stage.
The client tells the nurse, 'I thought my psychiatrist was the best doctor in the world. I thought he understood me completely. Now, I hate him! He doesn't understand me at all. He's just dumping me to go on a 2-week vacation.' The nurse assesses the client's description of feelings about the physician as evidence of the use of:
- A. Splitting
- B. Projective identification
- C. Isolation of affect
- D. Dissociation
Correct Answer: A
Rationale: The correct answer is A: Splitting. Splitting is a defense mechanism where a person sees things in extremes of either all good or all bad. In this scenario, the client initially idealizes the psychiatrist as the best doctor, then suddenly devalues and hates him for taking a vacation, indicating a shift from all good to all bad. This extreme change in perception is characteristic of splitting.
B: Projective identification involves projecting one's own feelings onto another person and then identifying with those projected feelings. This choice does not fit the scenario as the client is not projecting their feelings onto the psychiatrist.
C: Isolation of affect refers to the separation of feelings from ideas and events. The client's strong emotions towards the psychiatrist do not demonstrate a lack of emotional expression or detachment from feelings.
D: Dissociation is a defense mechanism where thoughts, feelings, and experiences are separated from conscious awareness. The client's reaction does not suggest a disconnection from reality or consciousness.
A patient with anorexia nervosa is being treated with refeeding. Which complication should the nurse monitor for during this phase?
- A. Hyperkalemia and hyperglycemia.
- B. Hypophosphatemia and cardiac arrhythmias.
- C. Increased appetite and food cravings.
- D. Dehydration and hypotension.
Correct Answer: B
Rationale: The correct answer is B: Hypophosphatemia and cardiac arrhythmias. During refeeding in anorexia nervosa, there is a risk of rapid shifts in electrolytes, particularly phosphorus, leading to hypophosphatemia which can cause cardiac arrhythmias. This is a critical complication that the nurse should monitor for. Hyperkalemia and hyperglycemia (choice A) are less common in refeeding syndrome. Increased appetite and food cravings (choice C) are expected outcomes of refeeding, not complications. Dehydration and hypotension (choice D) are potential issues but are not specific to refeeding in anorexia nervosa.
A patient with schizophrenia refuses to take his medication because he believes he is not ill. What phenomenon most likely underlies this presentation?
- A. The patient is unable to face having an illness and is in denial.
- B. Stigma causes the patient to refuse to admit his mental illness.
- C. The illness itself is preventing the patient from realizing he is ill.
- D. Command hallucinations are instructing him to deny the illness.
Correct Answer: C
Rationale: The correct answer is C because anosognosia, a symptom of schizophrenia, can prevent patients from recognizing they are ill due to the illness itself affecting their insight and awareness. Anosognosia is a neurocognitive deficit common in schizophrenia, where the brain's ability to recognize one's own illness is impaired. This leads the patient to genuinely believe they are not ill, even when presented with evidence to the contrary.
Choice A: Denial is a psychological defense mechanism, not a symptom of schizophrenia.
Choice B: Stigma might influence perceptions of mental illness, but it does not directly cause anosognosia in schizophrenia.
Choice D: Command hallucinations can influence behavior, but they typically involve auditory commands unrelated to recognizing one's illness.