Age Specific Considerations in Patient Care

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A patient being treated for major depression is the CEO of her own business. She has shown significant improvement and is about to be discharged after completing a course of 15 electroconvulsive therapy sessions. She will continue on SSRI medications. The patient has been counseled not to make a major business decision for a month. The rationale for this is that:

  • A. SSRIs may cause confusion in susceptible persons.
  • B. ECT often causes temporary memory impairment.
  • C. Lingering depression makes the patient incompetent.
  • D. The patient needs months to readjust to work pressures.
Correct Answer: B

Rationale: The correct answer is B: ECT often causes temporary memory impairment. This is because electroconvulsive therapy (ECT) is known to have side effects, including temporary memory loss and confusion. As the patient has just completed a course of 15 ECT sessions, it is important to allow time for the effects of ECT to subside before making major decisions, especially in a high-pressure role like being a CEO. Choices A and C are incorrect as SSRIs do not typically cause confusion and lingering depression alone does not necessarily make a patient incompetent. Choice D is incorrect as there is no indication that the patient needs months to readjust to work pressures; the primary concern here is the potential memory impairment from ECT.

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A client has been admitted with disorganized type schizophrenia. The nurse observes blunted affect and social isolation. The client occasionally curses or calls another client a 'jerk' without provocation. The nurse asks the client how he is feeling, and he responds, 'Everybody picks on me. They frobitz me.' The best response for the nurse to make would be:

  • A. That's really too bad.'
  • B. Who do you mean when you say 'everybody'?'
  • C. What difference does frobitzing make?'
  • D. Why do they frobitz?'
Correct Answer: B

Rationale: The correct answer is B: "Who do you mean when you say 'everybody'?"

Rationale:
1. Clarifying the client's statement helps to understand his perception.
2. Asking specifically about 'everybody' encourages the client to express his feelings and thoughts.
3. It promotes therapeutic communication by showing empathy and active listening.

Incorrect choices:
A: "That's really too bad." - This response does not address the client's specific concerns or promote further exploration.
C: "What difference does frobitzing make?" - This response is dismissive and lacks empathy or understanding of the client's experience.
D: "Why do they frobitz?" - This response is confrontational and may come across as accusatory, potentially shutting down communication.

Individuals with Down Syndrome often have moderate to severe intellectual impairment with a measurable IQ usually between:

  • A. 45-50
  • B. 55-60
  • C. 35-55
  • D. 25-35
Correct Answer: C

Rationale: Down Syndrome: A disorder caused by an extra chromosome 21, characterized by intellectual impairment with IQ typically between 35-55.

Joey is a 5-year-old who is causing his parents a lot of concern. His mother reports that he bounces off the walls all the time and cant focus on any one thing for very long. He is impulsive and has recently ran right out into the street in front of the familys home. His teacher has told his parents that he has done similar things at school. The nurse understands that:

  • A. Joey shows all the signs of having ADHD and should probably be placed on Ritalin as soon as possible
  • B. Joey is just an active, healthy child who needs to be disciplined more effectively
  • C. Joey could be autistic, and additional testing will have to be done to confirm the diagnosis
  • D. Joey shows signs of having ADHD, but is too young for that diagnosis to be made definitively now
Correct Answer: D

Rationale: Definitive diagnosis of ADHD should not be made before age 7 because developmentally the child has a shorter attention span.

The first step in the treatment of incest is to:

  • A. believe the child who reports the activity
  • B. notify the proper authorities
  • C. objectively confront the accused family member
  • D. remove the child from the home
Correct Answer: A

Rationale: Believing the child establishes trust and validates their experience, forming the foundation for further protective and therapeutic actions.

A client with borderline personality disorder is having difficulty with memories of sexual abuse. She has a history of suicidal gestures, self-mutilation, sexual addiction, and substance addiction. She complains of vague pains, menstrual problems, and headaches. She entered the partial hospital program to prevent another suicide gesture or self-mutilation. The nurse recognizes that collaborative therapy may be helpful for this client and knows that the most useful collaboration in this case would be the client, the nurse, and the:

  • A. Occupational therapist exploring ways to reduce stress
  • B. Physical therapist exploring ways to reduce back pain
  • C. Acupuncturist exploring ways to reduce pain
  • D. Sexologist exploring healthy sexuality and safe sex
Correct Answer: A

Rationale: The correct answer is A: Occupational therapist exploring ways to reduce stress. In this case, the client's symptoms and history suggest complex emotional issues related to trauma and addiction. Occupational therapy can help the client develop coping skills, manage stress, and improve functioning in daily activities. The therapist can work collaboratively with the client and nurse to address the client's emotional, physical, and social needs.

Choice B: Physical therapist exploring ways to reduce back pain focuses only on physical symptoms and does not address the underlying emotional issues. Choice C: Acupuncturist exploring ways to reduce pain also only addresses physical symptoms and does not provide comprehensive support for the client's mental health. Choice D: Sexologist exploring healthy sexuality and safe sex is not the most immediate need for the client, as her primary concerns are related to trauma, self-harm, and addiction.

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