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A nurse is working with a patient with anorexia nervosa. What is the priority assessment for this patient?
- A. Height and weight changes.
- B. Food intake and nutritional status.
- C. Mental health status and body image concerns.
- D. Vital signs and cardiovascular function.
Correct Answer: A
Rationale: The correct answer is A: Height and weight changes. In anorexia nervosa, monitoring height and weight is crucial to assess the severity of malnutrition and potential complications. Weight loss is a key indicator of the patient's nutritional status and overall health decline. Height measurement also helps determine growth patterns in younger patients.
Choice B: Food intake and nutritional status, although important, is not the priority as weight changes provide a more direct reflection of the patient's nutritional status.
Choice C: Mental health status and body image concerns are significant in anorexia nervosa, but assessing height and weight takes precedence due to the immediate physical risks associated with severe malnutrition.
Choice D: Vital signs and cardiovascular function are important, but monitoring height and weight is more specific to the nutritional deficiencies seen in anorexia nervosa.
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In Avoidant/Restrictive Food Intake Disorder (ARFID), which of the following is a characteristic clinical feature?
- A. Do not prefer foods with strong smells
- B. Do not prefer bland foods
- C. Do not have weight concerns
- D. Do not prefer solid foods
Correct Answer: C
Rationale: ARFID involves food avoidance without body image concerns, unlike AN; lack of weight concerns is a key feature per DSM-5.
The physician and advanced practice nurse are considering which antipsychotic medication to prescribe for a patient with schizophrenia who demonstrates auditory hallucinations, apathy, anhedonia, and poor social functioning. The patient is overweight and has hypertension. Bearing these facts in mind, the drug the nurse should advocate would be:
- A. clozapine (Clozaril).
- B. haloperidol (Haldol).
- C. olanzapine (Zyprexa).
- D. aripiprazole (Ability).
Correct Answer: D
Rationale: The correct answer is D: aripiprazole (Ability). Aripiprazole is a second-generation antipsychotic that is less likely to cause weight gain and metabolic side effects compared to other antipsychotics like clozapine (A), olanzapine (C), and haloperidol (B). Given that the patient is overweight and has hypertension, aripiprazole would be a better choice to minimize the risk of exacerbating these conditions. Additionally, aripiprazole has a lower risk of sedation, which can be beneficial for a patient with apathy and anhedonia, allowing for improved social functioning. Aripiprazole's unique mechanism of action as a partial dopamine agonist can also be advantageous for managing auditory hallucinations in schizophrenia. Therefore, aripiprazole is the most suitable choice for this patient based on their clinical presentation and comorbidities.
Which point should be included in teaching patients and families about relapse?
- A. Patients who relapse are those who have failed to take their medications.
- B. Caffeine and nicotine can reduce the effectiveness of antipsychotic drugs.
- C. With support, education, and adherence to treatment, patients will not relapse.
- D. Posthospitalization education about medication side effects is usually ineffective.
Correct Answer: B
Rationale: Step-by-step rationale for why answer B is correct:
1. Caffeine and nicotine are known to reduce the effectiveness of antipsychotic drugs.
2. Teaching patients and families about this can help them understand the importance of avoiding these substances.
3. By avoiding caffeine and nicotine, patients can improve the effectiveness of their treatment and reduce the risk of relapse.
4. This information empowers patients and families to make informed decisions to support treatment outcomes.
Summary of why other choices are incorrect:
A: Incorrect because relapse can occur due to various factors, not just medication non-adherence.
C: Incorrect because relapse is a complex issue that may not be entirely prevented even with support, education, and adherence.
D: Incorrect because education about medication side effects is still valuable, even if it may not entirely prevent relapse.
A new nurse asks, 'My elderly patient's CT scan of the head shows many Lewy bodies are present. What should I do about assessing for pain?' Select the best response from the nurse manager.
- A. Ask the patient's family if they think the patient is experiencing pain.
- B. Use a visual analog scale to help the patient determine the presence and severity of pain.
- C. There are special scales for assessing patients with dementia. Let's review how to use them.
- D. The perception of pain is diminished by this type of dementia. Focus your assessment on the patient's mental status.
Correct Answer: C
Rationale: The correct answer is C because patients with Lewy body dementia may have difficulty expressing pain. Special pain assessment scales designed for patients with dementia can help in accurately assessing pain levels. These scales take into account nonverbal cues and behavioral changes that may indicate pain. By using these specialized tools, the nurse can ensure a more comprehensive assessment of the patient's pain experience.
Choice A is incorrect because relying solely on family members' perceptions may not accurately reflect the patient's actual pain experience.
Choice B is not the best option because a visual analog scale may not be suitable for patients with dementia who may have cognitive impairments affecting their ability to use such tools effectively.
Choice D is incorrect as it assumes that pain perception is diminished in Lewy body dementia without considering that patients may still experience pain but have difficulty communicating it. Focusing solely on mental status may overlook important pain indicators.
An 18-year-old referred to the mental health center often cooks gourmet meals but eats only tiny portions. The patient wears layers of loose clothing saying, "I like the style."Â The patient's weight dropped from 130 to 95 pounds. She has amenorrhea. Which diagnosis is most likely?
- A. Eating disorder not otherwise specified
- B. Anorexia nervosa
- C. Bulimia nervosa
- D. Binge eating
Correct Answer: B
Rationale: The correct answer is B: Anorexia nervosa. This diagnosis fits the patient's symptoms of restrictive eating, significant weight loss, amenorrhea, and denial of the severity of the situation. The patient's behavior of cooking gourmet meals but eating tiny portions and wearing layers of clothes to hide weight loss are classic signs of anorexia nervosa. The other choices are incorrect because:
A: Eating disorder not otherwise specified does not fully capture the severity and specific symptoms exhibited by the patient.
C: Bulimia nervosa involves binge-eating followed by compensatory behaviors, which are not described in the scenario.
D: Binge eating disorder involves recurrent episodes of binge eating without compensatory behaviors, which is not indicated.