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A patient, aged 77 years, has Alzheimer's disease and lives with her daughter. While checking her blood pressure at the clinic, the nurse noticed fresh bruises on the patient's palms and buttocks. The patient could not explain these bruises. The nurse discussed her observations with the daughter, who became defensive and said that her mother was very difficult to manage. She stated, "My mother is getting worse every week. She is not my mother anymore. She can't recognize me, and she wanders all night. We take turns because she has to be watched constantly. Last night I fell asleep, and she fell down the stairs while wandering." Which statement is most accurate?

  • A. Reporting the injuries in this case is not indicated by available data.
  • B. The nurse should report the injuries as suggestive of elder abuse.
  • C. The nurse is only required to report the injury if the patient is incompetent.
  • D. The nurse is legally required to report the injuries as possible abuse.
Correct Answer: A

Rationale: Step 1: The nurse observed bruises on the patient's palms and buttocks.
Step 2: The patient could not explain these bruises.
Step 3: The daughter mentioned the patient's worsening condition and the incident of falling down the stairs.
Step 4: The daughter's statement indicates the patient's deteriorating cognitive and physical abilities.
Step 5: The daughter's challenges in managing the patient are due to the progression of Alzheimer's disease.
Step 6: There is no explicit evidence or indication of elder abuse based on the provided information.
Step 7: Reporting the injuries without clear signs of abuse may harm the patient's relationship with the daughter.
Step 8: Therefore, the most appropriate action is not to report the injuries based on the available data to avoid potential harm.
Summary:
- Choice A is correct as reporting the injuries is not indicated by the available data.
- Choices B, C, and D are incorrect as there is no clear evidence of elder abuse in the scenario

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A 70-year-old woman is beginning to notice mild memory impairment. She fears she is developing dementia. What is the most likely cause of her memory impairment?

  • A. Normal aging.
  • B. Alzheimer's disease.
  • C. Depression.
  • D. None of the above.
Correct Answer: B

Rationale: The correct answer is B: Alzheimer's disease. This is the most likely cause of memory impairment in a 70-year-old woman experiencing mild memory issues. Alzheimer's disease is a progressive neurodegenerative disorder that affects memory, thinking, and behavior. It is the most common cause of dementia in older adults. Normal aging (choice A) typically involves some mild memory decline, but significant impairment is not considered a normal part of aging. Depression (choice C) can also impact memory, but in this case, the woman's primary concern is memory impairment, not depressive symptoms. Choice D is incorrect as Alzheimer's disease is a possible explanation for her memory issues.

Which statement by a patient with an eating disorder reflects a correct understanding of the condition?

  • A. Gaining 1 pound is as much of a disaster as gaining 100 pounds.
  • B. I was happy when I was a size 4, so I must diet to that size.
  • C. I've been coping with my feelings by overeating.
  • D. Binging is the only way I can soothe myself.
Correct Answer: C

Rationale: The correct answer is C because it acknowledges the emotional aspect of eating disorders. Coping with feelings by overeating indicates insight into using food to manage emotions, a common characteristic of eating disorders. This understanding is crucial for addressing the underlying issues contributing to the disorder.

A: Incorrect. This statement suggests an extreme and distorted view of weight gain, which is not reflective of a healthy understanding of an eating disorder.
B: Incorrect. This statement implies a fixation on a specific size for happiness, which may perpetuate disordered eating behaviors.
D: Incorrect. This statement indicates reliance on binging as the sole coping mechanism, overlooking the emotional aspect of the disorder.

The home care nurse assessed a client with a history of dementia who had a herniorrhaphy at an ambulatory surgical center the previous day. The client lives in a senior living facility. The client thinks he is in the army and that it is 1945. The nurse should:

  • A. Reorient the client to the current time and place.
  • B. Notify the client's family of the confusion.
  • C. Document the client's confusion and disorientation.
  • D. None of the above.
Correct Answer: A

Rationale: The correct answer is A: Reorient the client to the current time and place. The nurse should reorient the client to prevent distress and promote safety. This approach helps the client feel more secure and may reduce confusion. Choice B is incorrect because the nurse should address the client's needs first. Choice C is not enough on its own as the nurse needs to actively assist the client. Choice D is incorrect as action is needed in this situation to support the client.

What is the most appropriate intervention for a patient with bulimia nervosa who is refusing to eat?

  • A. Encourage the patient to eat small, frequent meals without pressure.
  • B. Force the patient to eat larger meals to prevent further weight loss.
  • C. Allow the patient to skip meals to avoid feeling overwhelmed.
  • D. Focus only on addressing the patient's mental health concerns, not eating habits.
Correct Answer: A

Rationale: The correct answer is A because encouraging the patient to eat small, frequent meals without pressure promotes a balanced approach to eating. This intervention helps to establish a regular eating pattern and prevents episodes of binge-eating. It also respects the patient's autonomy and can help build trust between the patient and healthcare provider.

Choice B is incorrect because forcing the patient to eat larger meals can lead to increased anxiety and resistance, worsening the eating disorder. Choice C is incorrect as allowing the patient to skip meals can perpetuate unhealthy behaviors and reinforce the cycle of restriction and bingeing. Choice D is incorrect because neglecting the patient's eating habits can overlook a crucial aspect of their overall well-being and exacerbate the eating disorder.

A nurse observes a patient who is sitting alone in a room put hands over both ears and vigorously shake her head as though saying, 'No.' Later the patient cries and mutters, 'You don't know what you're talking about! Leave me alone.' What assessment should the nurse attempt to validate?

  • A. The patient is seeking the attention of staff.
  • B. The patient is inappropriately expressing emotion.
  • C. The patient is experiencing auditory hallucinations.
  • D. The patient is displaying negative symptoms of schizophrenia.
Correct Answer: C

Rationale: The correct answer is C: The patient is experiencing auditory hallucinations. The patient's behavior of covering both ears and shaking her head as if responding to voices, along with muttering and crying, suggests a sensory perception that is not based on external stimuli. This aligns with the characteristic symptoms of auditory hallucinations, which are common in conditions like schizophrenia.

Choice A is incorrect because the patient's behavior is not necessarily seeking attention but rather responding to internal stimuli. Choice B is incorrect as the patient's emotional expression seems to be a result of the auditory hallucinations rather than being inappropriate. Choice D is incorrect as negative symptoms of schizophrenia typically involve a decrease or absence of normal functions, which is not clearly demonstrated in this scenario.

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