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A nurse is working with a patient with bulimia nervosa. Which outcome would indicate successful intervention?
- A. The patient eats three full meals daily without purging.
- B. The patient agrees to begin psychotherapy without resistance.
- C. The patient loses 5% of their body weight over 3 months.
- D. The patient expresses improved body image but still purges occasionally.
Correct Answer: A
Rationale: The correct answer is A because it indicates successful intervention in bulimia nervosa by demonstrating healthy eating behavior without purging. This outcome reflects improved control over binge-purge cycles and supports physical health. Choices B and D show progress but do not directly address the core issue of purging behavior. Choice C, losing weight, can be a misleading indicator and may not necessarily reflect improved psychological and behavioral outcomes associated with recovery from bulimia nervosa.
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A 67-year-old woman recently noticed a non-painful lump in the right breast (see image). Which one of the following is the most likely diagnosis?
- A. Subacute mastitis with early abscess formation.
- B. Advanced adenocarcinoma of the breast.
- C. Early intraduct carcinoma with obstruction of ductal ampullae.
- D. Severe fibrocystic disease of the breast (fibroadenosis with multiple cysts).
Correct Answer: B
Rationale: A non-painful breast lump in a 67-year-old is most likely advanced adenocarcinoma (B), a common malignancy in this age group. Mastitis (A) is painful, early carcinoma (C) less likely advanced, and fibrocystic disease (D) or fat necrosis (E) are less typical without specific trauma or cysts.
A patient diagnosed with schizophrenia has been rehospitalized after a relapse. A priority intervention in designing a discharge plan to prevent relapses will be:
- A. helping the patient's family develop tolerance for the cognitive symptoms.
- B. mobilizing the family to provide structure to reduce social dysfunction.
- C. working on self-concept to reduce abolition, anhedonia, and dysphoria.
- D. early identification of signs of impending relapse and coping strategies.
Correct Answer: D
Rationale: The correct answer is D because early identification of signs of impending relapse and coping strategies are crucial in preventing relapses in schizophrenia. By recognizing early warning signs, the patient can receive timely intervention and support to prevent further deterioration. This proactive approach enables healthcare providers to adjust treatment plans and provide necessary resources, ultimately reducing the likelihood of rehospitalization.
Choice A is incorrect because developing tolerance for cognitive symptoms may be beneficial but not a priority in preventing relapses. Choice B is incorrect as family support is important but solely relying on family for structure may not address all factors contributing to relapse. Choice C is incorrect as working on self-concept may be helpful but not directly related to preventing relapses.
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.
A client with undifferentiated schizophrenia is readmitted for an acute exacerbation of the disorder. The goal of hospitalization is symptom stabilization. The nurse has documented that, in addition to experiencing auditory hallucinations, the client seems uninterested in activities, has difficulty completing tasks, seems forgetful, and seems puzzled by information and directions given by staff. The nurse's plans for intervention will be effective if these behaviors are attributed to:
- A. Social isolation
- B. Deficient knowledge
- C. Situational low self-esteem
- D. Problems in cognitive functioning
Correct Answer: D
Rationale: The correct answer is D: Problems in cognitive functioning. In undifferentiated schizophrenia, cognitive deficits are common, leading to difficulties in memory, attention, problem-solving, and executive functioning. The client's symptoms of forgetfulness, difficulty completing tasks, being puzzled by information, and auditory hallucinations are indicative of cognitive impairment. Interventions should focus on addressing these cognitive deficits to improve the client's ability to function.
Incorrect choices:
A: Social isolation - This choice does not address the cognitive deficits and symptoms described by the client, such as forgetfulness and difficulty completing tasks.
B: Deficient knowledge - While cognitive deficits may contribute to deficient knowledge, the primary concern in this scenario is the client's cognitive functioning impairments.
C: Situational low self-esteem - This choice does not explain the cognitive deficits and symptoms experienced by the client, which are more indicative of problems in cognitive functioning.
Major concerns of the elderly living alone in their home are: (Name 1)
- A. Safety
- B. Quality of life
- C. Support system
- D. Access to medical care
Correct Answer: A
Rationale: Safety (A) is a major concern for the elderly living alone, as it impacts their ability to remain independent and healthy. Other concerns like quality of life (B), support system (C), and medical access (D) are also relevant but asked as a single choice here.