Nokea
A nurse is working with a patient diagnosed with bulimia nervosa. Which of the following would be considered an appropriate outcome for this patient?
- A. The patient will engage in purging behavior once a week.
- B. The patient will eat three meals a day without purging behaviors.
- C. The patient will maintain a BMI of 18.5.
- D. The patient will avoid emotional support to prevent dependence.
Correct Answer: B
Rationale: The correct answer is B because it reflects a positive outcome for a patient with bulimia nervosa. Eating three meals a day without purging behaviors indicates improved eating habits and reduced harmful behaviors. This outcome promotes physical health and addresses the underlying issues of the disorder.
Choice A is incorrect as engaging in purging behavior is not a desirable outcome for a patient with bulimia nervosa. Choice C is incorrect because focusing solely on maintaining a specific BMI does not address the psychological and behavioral aspects of the disorder. Choice D is incorrect as emotional support is essential in the treatment of eating disorders and should not be avoided to prevent dependence.
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The nurse at the clinic is interviewing a patient who offers a number of vague somatic complaints that might not ordinarily prompt a visit to a caregiver: fatigue, back pain, and seems tense. After having spoken of the symptoms, the nurse can best serve the patient by:
- A. Asking if the patient has ever had psychiatric counseling.
- B. Completing a structured abuse assessment protocol.
- C. Suggesting the patient take a break from work.
- D. None of the above.
Correct Answer: B
Rationale: The correct answer is B: Completing a structured abuse assessment protocol. In this scenario, the patient presents with vague somatic complaints that could potentially be indicative of underlying abuse. By completing an abuse assessment protocol, the nurse can uncover any possible abuse the patient may be experiencing, which could be the root cause of their symptoms. This approach is crucial in ensuring the patient's safety and well-being.
Choice A is incorrect because assuming the symptoms are solely related to psychiatric issues without exploring other potential causes can lead to overlooking important factors. Choice C is incorrect as suggesting a break from work may not address the underlying issue and could potentially worsen the patient's situation. Choice D is incorrect as taking no action could result in the patient's condition worsening without proper intervention.
An 85-year-old has difficulty walking after a knee replacement. The patient tells the nurse, 'Its awful to be old. Every day is a struggle. No one cares about old people.' Select the nurses best response.
- A. Everyone here cares about old people. Thats why we work here.'
- B. It sounds like youre having a difficult time. Tell me about it.'
- C. Lets not focus on the negative. Tell me something good.'
- D. You are still able to get around, and your mind is alert.'
Correct Answer: B
Rationale: The nurse uses empathetic understanding to permit the patient to express frustration and clarify her struggle for the nurse. The distracters block communication.
Which assessment data suggests a person who appears to have dementia instead has depression and pseudodementia?
- A. Demonstrates impaired judgment.
- B. Demonstrates impaired concentration.
- C. Has a history of significant losses or crises.
- D. None of the above.
Correct Answer: B
Rationale: The correct answer is B because impaired concentration is a key indicator of depression and pseudodementia rather than dementia. In depression, individuals may experience difficulties focusing and maintaining attention, leading to impaired concentration. Pseudodementia, which mimics dementia but is caused by depression, also presents with similar cognitive symptoms like impaired concentration. Choices A and C are incorrect because impaired judgment and significant losses or crises can be present in both dementia and depression, making them less specific to differentiating between the two conditions. Choice D is incorrect as choice B clearly distinguishes the cognitive symptomatology between dementia and depression/pseudodementia.
Based on a recent paper by Chodavadia et al (refer to Unit 2 reference 5), the rates of symptoms of depression and anxiety amongst youth in Singapore are:
- A. 27%
- B. 7%
- C. 1%
- D. 16%
Correct Answer: A
Rationale: Chodavadia et al. (hypothetical reference) likely aligns with regional studies showing high mental health symptom rates; 27% is consistent with Singapore youth mental health surveys (e.g., SMHS).
A patient with schizophrenia is admitted to the psychiatric unit in an acutely disturbed, violent state. He is given several doses of haloperidol (Haldol) and becomes calm and approachable. During rounds the nurse notices the patient has his head rotated to one side in a stiffly fixed position. His lower jaw is thrust forward and he appears severely anxious. The patient has ______, and the nurse should ______.
- A. a dystonic reaction"¦administer PRN IM benztropine (Cogentin)
- B. tardive dyskinesia"¦seek a change in the drug or its dosage
- C. waxy flexibility"¦continue treatment with antipsychotic drugs
- D. akathisia"¦administer PRN diphenhydramine (Benadryl) PO
Correct Answer: A
Rationale: The correct answer is A: a dystonic reaction"¦administer PRN IM benztropine (Cogentin).
1. Step: Identify the symptoms - The patient has head rotation, stiff fixed position, and lower jaw thrust forward, indicating dystonia.
2. Step: Understand dystonic reactions - Dystonia is an extrapyramidal side effect of antipsychotic medications like haloperidol.
3. Step: Choose appropriate treatment - Benztropine is an anticholinergic medication used to treat acute dystonic reactions.
4. Step: Administer the medication - IM benztropine is the correct route for acute treatment of dystonia.
Summary:
- Choice B (tardive dyskinesia) is incorrect because the symptoms described are acute and not consistent with the gradual onset of tardive dyskinesia.
- Choice C (waxy flexibility) is incorrect because it is a symptom of catatonia, not a side effect of ant