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A nurse is caring for a patient with bulimia nervosa. What is a priority assessment for this patient?
- A. Electrolyte imbalances and cardiac function.
- B. Body image issues and mental health status.
- C. Nutritional status and hydration levels.
- D. Weight changes and exercise patterns.
Correct Answer: A
Rationale: The correct answer is A: Electrolyte imbalances and cardiac function. This is because patients with bulimia nervosa often engage in purging behaviors which can lead to electrolyte imbalances and cardiac complications. Assessing electrolyte levels and cardiac function is crucial to prevent life-threatening complications.
Choice B is incorrect because while body image and mental health are important considerations, they are not the priority assessment in this case. Choice C is also incorrect as nutritional status and hydration levels can be affected, but not as immediately life-threatening as electrolyte imbalances and cardiac issues. Choice D is incorrect as weight changes and exercise patterns may be important, but they are not the priority assessment for a patient with bulimia nervosa.
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Which is the most appropriate response when a patient with bulimia nervosa expresses feelings of shame about their purging behaviors?
- A. Encourage the patient to avoid discussing their eating habits.
- B. Agree with the patient's feelings and offer reassurance.
- C. Focus on helping the patient identify triggers for purging behaviors.
- D. Provide education on the benefits of purging for weight management.
Correct Answer: C
Rationale: The correct answer is C because focusing on helping the patient identify triggers for purging behaviors is essential in addressing the underlying issues contributing to their behavior. By identifying triggers, the patient can develop coping strategies and alternative behaviors.
Choice A is incorrect as avoiding discussing eating habits can hinder progress in therapy. Choice B is incorrect as simply agreeing and offering reassurance without addressing the root cause may not lead to lasting change. Choice D is incorrect as it promotes the harmful behavior of purging for weight management, which goes against the goal of treating bulimia nervosa.
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.
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.
An elderly patient brings a bag of medications to the clinic. The nurse finds a bottle labeled Ativan and one labeled lorazepam, both of which are to be taken BID. There are also bottles labeled hydrochlorothiazide, Inderal, and rofecoxib, each to be taken once daily. Which conclusion is accurate?
- A. Rofecoxib should not be taken with Ativan.
- B. Lorazepam interferes with the action of Inderal.
- C. The patient should not self-administer medication.
- D. Lorazepam and Ativan are the same drug, so the dose is excessive.
Correct Answer: D
Rationale: Lorazepam and Ativan are generic and trade names for the same drug (D), creating an accidental misuse situation with an excessive dose. The patient needs medication education and help with proper labeling; there is no evidence they cannot self-administer (C). Options A and B are not factually supported.
Which of the following is not a common characteristic of oppositional behaviour?
- A. Saying no to requests
- B. Accepting responsibility for mistakes
- C. Unwilling to accept changes to routines or environments
- D. Refusing to follow instructions
Correct Answer: B
Rationale: Accepting responsibility for mistakes is not typical of oppositional behavior, which often involves defiance and blame-shifting.