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A nurse is working with a patient diagnosed with bulimia nervosa. Which of the following would indicate the need for further education?
- A. I know that purging is harmful to my health, but I continue to do it.
- B. I feel better after purging, but I realize it is not a long-term solution.
- C. I can control my eating and purging behaviors without help from others.
- D. I am working with my healthcare team to improve my eating habits and emotional health.
Correct Answer: C
Rationale: The correct answer is C because it indicates a lack of awareness about the severity of the disorder. Choice A acknowledges the harm of purging but struggles to stop, showing insight. Choice B recognizes the temporary relief of purging but understands the need for a better solution. Choice D demonstrates active engagement with healthcare professionals for support. In contrast, choice C suggests overconfidence in managing the disorder independently, which can hinder recovery progress. It is crucial for individuals with bulimia nervosa to acknowledge the need for professional help and support.
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A 19-year-old woman, prescribed a triphasic oral contraceptive for the first time one month ago, complains of frequent spotting. Which one of the following is the most appropriate management?
- A. Increase the dose of oestrogen.
- B. Increase the dose of progestogen.
- C. Advise alternative contraception.
- D. Continue the medication and review in two months.
Correct Answer: D
Rationale: Spotting is common in the first few months of oral contraceptives as the body adjusts. Continuing the medication and reviewing later (D) is standard, rather than immediate dose changes (A, B), switching methods (C, E) without trial.
The mother of a client newly diagnosed with schizophrenia is a nurse. She unhappily tells the nurse on the unit, 'I've tried to be a good mother, but my daughter still developed schizophrenia. When I was in school, we were taught that it was the mother's fault if a child became schizophrenic. I wish I knew what I did wrong.' The response that would help the mother evaluate models explaining schizophrenia would be:
- A. I can see how you would be upset over this turn of events.'
- B. New findings suggest this disorder is biologic in nature.'
- C. Don't be so hard on yourself; your daughter needs you to be strong.'
- D. It's difficult to see that double-bind communication produces stress for the child at the time it's occurring.'
Correct Answer: B
Rationale: Correct Answer: B
Rationale:
1. Choice B is the correct answer because it provides the mother with new information that schizophrenia is biologic in nature, shifting the blame away from her.
2. This response helps the mother understand that her daughter's condition is not her fault, based on current scientific understanding.
3. By offering this information, the nurse helps the mother reevaluate her beliefs and perceptions about the causes of schizophrenia.
4. Choices A, C, and D do not address the mother's concerns directly or provide her with the necessary information to understand the biological basis of schizophrenia.
A client seen by the rape crisis nurse 1 month after the incident states, 'I'm confused and just not myself. I have mood swings during the day, and I have nightmares at night. Sometimes I think I'm going crazy.' Other times, she is just plain afraid to be alone. The nurse should assess the client for:
- A. Trauma syndrome.
- B. Post-traumatic stress disorder.
- C. Acute stress disorder.
- D. None of the above.
Correct Answer: A
Rationale: The correct answer is A: Trauma syndrome. This choice is correct because the client's symptoms of confusion, mood swings, nightmares, feeling like they are going crazy, and fear of being alone align with the criteria for trauma syndrome. This syndrome encompasses a range of symptoms that occur after experiencing a traumatic event, such as rape.
Choice B: Post-traumatic stress disorder (PTSD) is not the best option in this case because the client's symptoms are more indicative of acute distress and confusion rather than the criteria for a formal diagnosis of PTSD, which typically requires the persistence of symptoms over time.
Choice C: Acute stress disorder is also not the most appropriate choice because while some symptoms may align, the duration and specific criteria for this disorder may not fully match the client's presentation.
Choice D: None of the above is incorrect as trauma syndrome best fits the client's symptoms based on the information provided.
A 75-year-old male client is brought to the clinic by his son. The son states, 'Ever since Mom died, Dad hasn't been the same. At first he just seemed sad, but now he seems to get mixed up about everything.' The nurse is aware that based on the client's history, the source of confusion is most likely:
- A. Dementia
- B. Depression from the loss of his wife
- C. Hypoxia of the brain
- D. Delirium from medications
Correct Answer: B
Rationale: Correct Answer: B - Depression from the loss of his wife
Rationale: Given the client's recent loss of his wife and subsequent changes in behavior, the most likely cause of his confusion is depression. Depression can manifest as cognitive impairment in older adults, leading to symptoms such as confusion and memory problems. Additionally, grief and loss can exacerbate depressive symptoms in elderly individuals, further contributing to cognitive difficulties.
Summary of other choices:
A: Dementia - Dementia typically presents with gradual cognitive decline over time, not a sudden onset following a specific event like the loss of a loved one.
C: Hypoxia of the brain - Hypoxia would likely present with more acute symptoms and physical signs, such as shortness of breath or cyanosis.
D: Delirium from medications - Delirium is characterized by acute onset and fluctuating course, often related to medication changes or other medical conditions, rather than an emotional trigger like grief.
A patient has anorexia nervosa. The history shows the patient virtually stopped eating 5 months ago and lost 25% of body weight. The serum potassium is 2.7 mg/dL. Which nursing diagnosis applies?
- A. Adult failure to thrive related to abuse of laxatives, as evidenced by electrolyte imbalances and weight loss
- B. Ineffective health maintenance related to self-induced vomiting, as evidenced by swollen parotid glands and hyperkalemia
- C. Disturbed energy field related to physical exertion in excess of energy produced through caloric intake, as evidenced by weight loss and hyperkalemia
- D. Imbalanced nutrition: less than body requirements related to refusal to eat, as evidenced by loss of 25% of body weight and hypokalemia
Correct Answer: D
Rationale: The correct answer is D: Imbalanced nutrition: less than body requirements related to refusal to eat, as evidenced by loss of 25% of body weight and hypokalemia.
Rationale:
1. Anorexia nervosa involves severe restriction of food intake, leading to significant weight loss and malnutrition.
2. The patient's history of virtually stopping eating and losing 25% of body weight aligns with the nursing diagnosis of imbalanced nutrition.
3. Hypokalemia (low serum potassium level) is common in patients with anorexia nervosa due to inadequate intake or purging behaviors.
4. The other choices are incorrect because they do not match the patient's specific presentation of anorexia nervosa and hypokalemia.