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A nurse is caring for a patient with anorexia nervosa who is refusing to eat. What should the nurse do first?
- A. Provide a structured meal plan and encourage the patient to eat.
- B. Avoid discussing food intake to reduce anxiety.
- C. Allow the patient to skip meals to avoid pressure.
- D. Offer incentives for eating a full meal.
Correct Answer: A
Rationale: The correct answer is A: Provide a structured meal plan and encourage the patient to eat. This is the first step because patients with anorexia nervosa often struggle with disordered eating behaviors and need guidance and support to establish healthy eating habits. Providing a structured meal plan helps the patient understand the importance of regular and balanced meals. Encouraging the patient to eat helps address their resistance and fear around food.
Incorrect choices:
B: Avoid discussing food intake to reduce anxiety - This choice is incorrect because avoiding discussing food intake does not address the underlying issue and may perpetuate the patient's disordered eating behavior.
C: Allow the patient to skip meals to avoid pressure - Allowing the patient to skip meals enables their unhealthy behavior and does not promote recovery.
D: Offer incentives for eating a full meal - While incentives may be used as a motivational tool, they do not address the core issue of establishing a healthy relationship with food.
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A patient with schizophrenia has received typical (first-generation) antipsychotics for a year. His hallucinations are less intrusive, but he remains apathetic, has poverty of thought, cannot work, and is socially isolated. To address these symptoms, the nurse might consult the prescribing health care provider to suggest a change to:
- A. haloperidol (Haldol).
- B. olanzapine (Zyprexa).
- C. diphenhydramine (Benadryl).
- D. chlorpromazine (Thorazine).
Correct Answer: B
Rationale: The correct answer is B: olanzapine (Zyprexa). Olanzapine is an atypical (second-generation) antipsychotic that is known to be effective in treating negative symptoms of schizophrenia, such as apathy, poverty of thought, and social withdrawal. These symptoms are often resistant to typical antipsychotics like haloperidol (A) and chlorpromazine (D), which are more effective for positive symptoms like hallucinations. Diphenhydramine (C) is an antihistamine and not used to treat schizophrenia symptoms. In summary, olanzapine is the best choice to address the specific symptoms described in the scenario.
Which nursing diagnosis is more relevant for a patient with anorexia nervosa who restricts intake and is 20% below normal weight than for a 130-pound patient with bulimia nervosa who purges?
- A. Powerlessness
- B. Ineffective coping
- C. Disturbed body image
- D. Imbalanced nutrition: less than body requirements
Correct Answer: D
Rationale: The correct answer is D, Imbalanced nutrition: less than body requirements. For a patient with anorexia nervosa who restricts intake and is 20% below normal weight, this diagnosis is more relevant as it directly addresses the issue of inadequate food intake leading to weight loss. Powerlessness (A) may not be as directly related to the physical consequences of anorexia. Ineffective coping (B) and Disturbed body image (C) are more commonly associated with bulimia nervosa and do not address the primary concern of malnutrition in this case.
When a patient with a personality disorder uses manipulation as a way of getting needs met, the staff agree to use limit setting as an intervention. How does limit setting work to reduce manipulation?
- A. Limit setting indulges the patient's desire for attention from staff.
- B. It gives the patient a different concern on which to focus his anger.
- C. External controls provide security while internal controls are developing.
- D. When staff limit the patient's behavior, he is no longer anxious about it.
Correct Answer: C
Rationale: Correct Answer: C
Rationale:
1. External controls, like limit setting, provide structure and predictability for the patient.
2. This security allows the patient to gradually develop internal controls to manage their behavior.
3. By relying on external limits, the patient's need for manipulation decreases over time.
4. This approach fosters growth and autonomy in the patient, reducing the reliance on manipulative behaviors.
Summary:
A: Incorrect. Limit setting does not indulge attention-seeking behaviors; it establishes boundaries.
B: Incorrect. Limit setting does not redirect anger; it focuses on promoting internal control.
D: Incorrect. Limit setting does not solely address anxiety; it aims to foster self-regulation.
When a psychiatric technician questions the nurse about comorbidity of eating disorders, which Axis I disorder would the nurse say is most commonly seen in clients with bulimia and anorexia nervosa?
- A. Anxiety disorders.
- B. Depressive disorders.
- C. Dissociative disorders.
- D. Somatoform disorders.
Correct Answer: B
Rationale: The correct answer is B: Depressive disorders. Depression is commonly seen in clients with bulimia and anorexia nervosa due to the psychological and emotional struggles associated with these eating disorders. Individuals may experience feelings of worthlessness, hopelessness, and sadness, contributing to depressive symptoms. This comorbidity is well-documented in clinical research. Anxiety disorders (Choice A), dissociative disorders (Choice C), and somatoform disorders (Choice D) are less commonly associated with eating disorders compared to depressive disorders, making them incorrect choices in this context.
A victim of physical abuse by her domestic partner is being treated for a broken humerus. Which indicator for the outcome of Abuse protection is most important to achieve before the patient leaves the emergency department?
- A. The patient has completed and reviewed a workable safety plan.
- B. She agrees to seek a restraining order limiting contact by the perpetrator.
- C. The patient demonstrates insight into the abusive nature of the relationship.
- D. She has been referred to counseling and battered-person support groups.
Correct Answer: A
Rationale: The correct answer is A because a safety plan is crucial for the victim's immediate safety and future protection. It helps the victim know what to do in case of danger, ensuring a proactive approach to safety. Choice B may not always be feasible or effective in preventing further abuse. Choice C, while important, does not guarantee safety outside the emergency department. Choice D is beneficial but does not address the immediate safety concerns as effectively as having a safety plan in place. Thus, completing and reviewing a workable safety plan is the most important indicator for the outcome of abuse protection in this scenario.