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A nurse is anxious about assessing the sexual history of a patient who is considerably older than the nurse is. Which statement would be most appropriate for obtaining information about the patient's sexual practices?
- A. Some people are not sexually active, others have a partner, and some have several partners. What has been your pattern?
- B. Sexual health can reflect a number of medical problems, so I'd like to ask if you have any sexual problems you think we should know about.
- C. It's your own business, of course, but it might be helpful for us to have some information about your sexual history. Could you tell me about that, please?
- D. I would appreciate it if you could share your sexual history with me so I can share it with your health care provider. It might be helpful in planning your treatment.
Correct Answer: A
Rationale: The correct answer is A because it acknowledges the diversity of sexual practices and respects the patient's autonomy in sharing their sexual history. It also allows the patient to openly discuss their pattern without feeling pressured.
Choice B is incorrect because it focuses on potential medical problems rather than directly asking about the patient's sexual practices.
Choice C is incorrect as it may come across as too intrusive and lacks a non-judgmental approach.
Choice D is incorrect as it implies the patient's information will be shared without their consent, which violates patient confidentiality.
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Which of the following medications would NOT be recommended for prescription by a Family Doctor for a depressed adolescent who also has panic attacks?
- A. Sertraline
- B. Amitriptyline
- C. Propranolol
- D. Lorazepam
Correct Answer: D
Rationale: Lorazepam, a benzodiazepine, is not recommended for adolescents due to dependency risks; SSRIs like Sertraline are preferred.
A victim of spousal abuse comes to the emergency department for treatment of a broken arm. She appears hypervigilant and anxious and admits to sleep disturbance when the nurse questions the dark circles under her eyes. She reluctantly tells the nurse the abuse usually occurs when the husband has been drinking, although she concedes he is always jealous and controlling. She is a stay-at-home mother of two preschool children. The family has lived in this town for 1 month. The patient states she has fleetingly considered suicide but must stay alive to care for her children and work her way out of the abusive relationship. She denies any further suicidal thoughts. The nurse should document in the medical record that: (Select all that apply.)
- A. Signs of high anxiety and chronic stress are present.
- B. The patient relies on the perpetrator for basic needs.
- C. The patient has a history of suicidal ideation.
- D. None of the above.
Correct Answer: A
Rationale: The correct answer is A: Signs of high anxiety and chronic stress are present.
Rationale:
1. The patient displaying hypervigilance, anxiety, sleep disturbances, and dark circles under her eyes are indicators of high anxiety and chronic stress, common in victims of abuse.
2. Mentioning abuse occurring when the husband drinks, his jealousy, and control further support the presence of chronic stress and anxiety.
3. The patient's fleeting suicidal thoughts are a response to the abusive situation, not indicative of a history of suicidal ideation.
Summary:
B: The patient relying on the perpetrator for basic needs is not supported by the information provided.
C: There is no indication of a history of suicidal ideation, as the patient's thoughts are tied to her children and escaping the abusive relationship.
A couple in counseling reports fighting with their child when they are angry with each other. This behavior typifies:
- A. coalition
- B. indirect communication
- C. transference
- D. triangulation
Correct Answer: D
Rationale: Triangulation occurs when a third party (the child) is drawn into a conflict between two others, redirecting tension.
Which remarks by a 72-year-old patient should prompt the nurse to assess for depression? Select one tha does not apply.
- A. Lately I have had a lot of aches and pains and just havent felt very well.
- B. People are in and out of my room all day and all night taking my things.
- C. Dont ask me to eat. I cant because my stomach is upset all the time.
- D. Im eating more than usual, and I am sleeping about 6 hours a night.
Correct Answer: D
Rationale: Somatic symptoms (A), delusions of persecution (B), and nihilistic delusions (C) are common in late-onset depression, warranting assessment. Increased appetite and contentment (D, E) do not suggest depression.
A client has been admitted with disorganized type schizophrenia. The nurse observes blunted affect and social isolation. The client occasionally curses or calls another client a 'jerk' without provocation. The nurse asks the client how he is feeling, and he responds, 'Everybody picks on me. They frobitz me.' The best response for the nurse to make would be:
- A. That's really too bad.'
- B. Who do you mean when you say 'everybody'?'
- C. What difference does frobitzing make?'
- D. Why do they frobitz?'
Correct Answer: B
Rationale: The correct answer is B: "Who do you mean when you say 'everybody'?" This response is the best because it acknowledges the client's feelings and seeks clarification. By asking for specifics, the nurse can gain a better understanding of the client's perceptions and experiences, which can help in providing appropriate care and support.
Choice A: "That's really too bad." This response lacks empathy and does not address the client's concerns directly.
Choice C: "What difference does frobitzing make?" This response is dismissive and does not focus on the client's feelings or experiences.
Choice D: "Why do they frobitz?" This response is confrontational and may make the client feel defensive, hindering effective communication and rapport-building.