Age Specific Care

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A nurse has completed the assessment for a patient who has a maladaptive response to eating regulation. Findings include the following: height, 5 feet 3 inches; current weight, 80 pounds with weight loss of 30% of body weight over the past 3 months; T, 96.6m F; BP, 68/40; P, 40; R, 20; poor skin turgor; lanugo; amenorrhea of 6 months' duration; admits to restricting intake to 350 calories daily; dissatisfied with eating pattern as evidenced by patient statement, 'I need to lose another 10 pounds to be at an ideal weight.' These assessment findings are most consistent with the medical diagnosis of:

  • A. bulimia nervosa.
  • B. anorexia nervosa.
  • C. binge-eating disorder.
  • D. disturbed body image.
Correct Answer: B

Rationale: The correct answer is B: Anorexia nervosa. The assessment findings align with the diagnostic criteria for anorexia nervosa, including significant weight loss, restrictive eating patterns, distorted body image, amenorrhea, and physical signs like poor skin turgor and lanugo. The patient's extreme weight loss, restrictive calorie intake, dissatisfaction with weight despite being underweight, and other physical and psychological symptoms are classic indicators of anorexia nervosa.

Incorrect Choices:
A: Bulimia nervosa involves binge eating followed by compensatory behaviors, which are not evident in this case.
C: Binge-eating disorder involves recurrent episodes of binge eating without compensatory behaviors, which are not present here.
D: Disturbed body image may be present in anorexia nervosa, but the key features of weight loss, restrictive eating, and amenorrhea are more indicative of anorexia nervosa.

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What is the correct assessment for a patient with bulimia nervosa who frequently engages in purging behaviors?

  • A. Observe for parotid gland enlargement and dehydration.
  • B. Assess for fluid retention and leg swelling.
  • C. Perform regular weight checks to assess for weight loss.
  • D. Evaluate for signs of hyperactivity and poor sleep.
Correct Answer: A

Rationale: The correct assessment for a patient with bulimia nervosa who frequently engages in purging behaviors is to observe for parotid gland enlargement and dehydration. Parotid gland enlargement is a common physical manifestation due to repeated vomiting, and dehydration can result from purging behaviors. This assessment is crucial in monitoring the patient's physical health and identifying potential complications. Assessing for fluid retention and leg swelling (Choice B) is more typical in conditions like heart failure. Performing weight checks (Choice C) may not accurately reflect the patient's health status due to fluid shifts. Evaluating for signs of hyperactivity and poor sleep (Choice D) are not directly related to the immediate physical consequences of purging behaviors.

A school-aged patient with attention-deficit hyperactivity disorder (ADHD) is displaying disruptive behaviors at home. The psychiatric-mental health nurse modifies the treatment plan for the social domain, by advising the patient's parents to:

  • A. establish eye contact before giving directions
  • B. initiate a point system, to reward the patient for appropriate behavior
  • C. instruct the patient to work on one homework assignment at a time
  • D. maintain a predictable environment in the home
Correct Answer: B

Rationale: A point system reinforces positive behavior, directly addressing social disruptiveness in ADHD.

A 63-year-old female has been admitted to the hospital for cholecystitis. She is accompanied by her sister, who provides all the assessment data while the client sits and stares somewhat vacantly. You determine that the client is single, lives alone, and lost her job as a secretary last year when she was unable to learn a new computer system. The sister states she has recently had to manage the client's shopping, meal preparation, and finances. Which of the following are appropriate nursing diagnoses?

  • A. Pain, self-care deficits, situational low self-esteem
  • B. Anxiety, self-care deficits, disturbed thought processes
  • C. Impaired home maintenance, disturbed thought process, impaired verbal communication
  • D. Disturbed body image, anxiety, pain
Correct Answer: C

Rationale: The correct answer is C: Impaired home maintenance, disturbed thought process, impaired verbal communication.
Rationale:
1. Impaired home maintenance: The client is unable to take care of herself and her living environment due to the need for assistance in shopping, meal preparation, and finances.
2. Disturbed thought process: The client's vacant stare and inability to learn new tasks suggest cognitive impairment or confusion.
3. Impaired verbal communication: The client's lack of verbal interaction and reliance on her sister for assessment data indicate difficulties in expressing herself.

Summary:
A: Pain, self-care deficits, situational low self-esteem - Pain is not mentioned in the scenario, and the client's issues go beyond self-care deficits and low self-esteem.
B: Anxiety, self-care deficits, disturbed thought processes - While anxiety and disturbed thought processes may be present, impaired home maintenance and impaired verbal communication are more appropriate diagnoses based on the scenario.
D: Disturbed body image, anxiety, pain - Disturbed

A physically frail elderly patient with mild cognitive impairments needs services of a facility that can provide supervision and safety as well as recreation and social interaction. The family cares for this patient during the evening and night. Which type of facility should the nurse suggest to meet this patient's needs?

  • A. Adult day care program
  • B. Skilled nursing facility
  • C. Partial hospitalization
  • D. Group home
Correct Answer: A

Rationale: The correct answer is A: Adult day care program. This option is suitable as it provides supervision, safety, recreation, and social interaction during the day while allowing the family to care for the patient in the evening and night. Adult day care programs offer a structured environment with trained staff to ensure the patient's safety and provide social engagement.

- Option B, Skilled nursing facility, is not the best choice as it usually provides round-the-clock care, which may not be necessary in this case.
- Option C, Partial hospitalization, is more focused on intensive psychiatric treatment and therapy, which may not align with the patient's needs.
- Option D, Group home, is designed for individuals who need 24-hour care and supervision, which exceeds the patient's current requirements.

A woman tells the nurse that her husband abuses her most often when he is intoxicated, just as his father had beaten him and his mother. The woman is aware of the location of a safe house and has considered leaving home with her two children, but she cites being brought up to believe 'you keep quiet and stay together, no matter what happens.' She states the husband is always apologetic and remorseful after an incident. What evidence exists that the husband is at risk of becoming a perpetrator of physical abuse? He:

  • A. is unable to make lasting behavioral changes.
  • B. was an abused child.
  • C. is without a job.
  • D. experiences remorse.
Correct Answer: B

Rationale: The correct answer is B because the husband's history of being abused as a child increases his risk of becoming a perpetrator of physical abuse. Research shows that individuals who have been abused are more likely to perpetrate abuse themselves. This is due to a cycle of violence where behaviors learned in childhood are repeated in adulthood. In this case, the husband's abusive behavior towards his wife mirrors his own upbringing where his father abused his mother. This pattern suggests that the husband may continue the cycle of abuse.

Choice A (is unable to make lasting behavioral changes) is incorrect because it does not directly correlate with the risk of becoming a perpetrator of physical abuse. Choice C (is without a job) is also incorrect as employment status does not necessarily indicate a propensity for abuse. Choice D (experiences remorse) is incorrect as feeling remorse after abusive incidents does not negate the risk of becoming a perpetrator of physical abuse.

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