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A nurse is caring for a patient who has a maladaptive response to eating regulation. The patient tells the nurse, 'I know my parents are already upset, but I need to lose another 10 pounds to be at an ideal weight.' This statement suggests that the best treatment setting for this patient would be:
- A. the hospital.
- B. an outpatient program.
- C. a day treatment program.
- D. at home with weekly nursing visits.
Correct Answer: A
Rationale: The correct answer is A: the hospital. This patient's maladaptive eating behavior and desire to lose more weight despite concerns from family indicate a serious condition requiring intensive care and monitoring. In the hospital, the patient can receive immediate medical attention, nutritional support, and psychological intervention to address underlying issues. Outpatient programs (B) may not offer sufficient supervision, while day treatment programs (C) may not provide round-the-clock care. Home with weekly nursing visits (D) is not appropriate for a patient with such severe eating regulation issues.
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A patient diagnosed with dementia associated with excessive alcohol use is shown a pencil, a nickel, and a safety pin and asked to repeat the names of each. Later when asked to identify the same three items the patient is unable to do so. The nurse assesses this as:
- A. apraxia.
- B. agnosia.
- C. concreteness.
- D. catastrophizing.
Correct Answer: B
Rationale: The correct answer is B: agnosia. Agnosia is the inability to recognize or identify objects despite intact sensory abilities. In this case, the patient's inability to identify the pencil, nickel, and safety pin suggests a deficit in object recognition, which aligns with agnosia.
A: Apraxia is the inability to perform purposeful movements despite intact motor function, not related to object recognition.
C: Concreteness refers to difficulty understanding abstract concepts, not object recognition.
D: Catastrophizing is an irrational belief that something is far worse than it actually is, not related to the patient's inability to identify objects.
A 28-year-old female client was admitted 3 days ago after she ran nude through the streets, shouting that she was the 'Queen of Hearts.' The client has remained delusional since admission. An initial expected outcome would be that the client will:
- A. Allow the nurse to logically dispute the delusion
- B. Distinguish external boundaries
- C. Engage in reality-oriented conversation
- D. Explain why she thinks she is the 'Queen of Hearts'
Correct Answer: C
Rationale: The correct answer is C: Engage in reality-oriented conversation. This is the most appropriate initial expected outcome because it focuses on helping the client ground herself in reality. Engaging in reality-oriented conversation can help the client understand and acknowledge her delusions, leading to potential insight and eventual treatment.
A: Allowing the nurse to logically dispute the delusion may not be effective initially as the client may not be receptive to this approach during the acute phase of her delusion.
B: Distinguishing external boundaries may not address the underlying delusional beliefs and may not be the most immediate concern.
D: Explaining why she thinks she is the 'Queen of Hearts' may reinforce the delusion rather than challenging it.
The nurse performs a functional assessment of a client upon admission to a home health service. The purpose of this assessment is to determine the client's:
- A. Level of consciousness
- B. Ability to perform activities of daily living
- C. Degree of reasoning, judgment, and thought processes
- D. Level of functioning memory
Correct Answer: B
Rationale: The correct answer is B: Ability to perform activities of daily living. A functional assessment in home health services focuses on evaluating the client's ability to independently perform daily tasks such as bathing, dressing, and preparing meals. This assessment helps determine the client's level of independence and need for assistance. Choices A, C, and D are incorrect because they do not directly assess the client's ability to perform activities of daily living, which is the primary purpose of a functional assessment in this context.
A patient tells the nurse that his sexual functioning is normal when his wife wears short, red camisole-style nightgowns. He states, 'Without the red teddies, I am not interested in sex.' The nurse can assess this as consistent with
- A. exhibitionism.
- B. voyeurism.
- C. frotteurism.
- D. fetishism.
Correct Answer: D
Rationale: The correct answer is D: fetishism. Fetishism is a sexual disorder where a person is sexually aroused by an object or body part that is not typically considered sexual. In this scenario, the patient's arousal is dependent on his wife wearing a specific type of clothing (the red camisole-style nightgowns), indicating a fetishistic preference for that particular item. This is different from exhibitionism (A), which involves exposing one's genitals to unsuspecting strangers; voyeurism (B), which involves observing unsuspecting individuals undressing or engaging in sexual activity; and frotteurism (C), which involves touching or rubbing against a non-consenting person for sexual arousal.
A patient living independently had command hallucinations to shout warnings to neighbors. After a short hospitalization, the patient was prohibited from returning to the apartment. The landlord said, 'You cause too much trouble.' What problem is the patient experiencing?
- A. Grief
- B. Stigma
- C. Homelessness
- D. Nonadherence
Correct Answer: B
Rationale: The inability to obtain shelter because of negative attitudes about mental illness is an example of stigma. Stigma is defined as damage to reputation, shame, and ridicule society places on mental illness. Data are not present to identify grief as a patient problem. Data do not suggest that the patient is actually homeless.