Age Specific Care Competency

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A patient diagnosed with a serious mental illness died suddenly at age 52. The patient lived in the community for 5 years without relapse and held supported employment the past 6 months. The distressed family asks, 'How could this happen?' Which response by the nurse accurately reflects research and addresses the family's question?

  • A. A certain number of people die young from undetected diseases, and its just one of those sad things that sometimes happen.'
  • B. Mentally ill people tend to die much younger than others, perhaps because they do not take as good care of their health, smoke more, or are overweight.'
  • C. We will have to wait for the autopsy to know what happened. There were some medical problems, but we were not expecting death.'
  • D. We are all surprised. The patient had been doing so well and saw the nurse every other week.'
Correct Answer: B

Rationale: The family is in distress. Because they do not understand his death, they are less able to accept it and seek specific information to help them understand what happened. Persons with serious mental illness die an average of 25 years prematurely. Contributing factors include failing to provide for their own health needs (e.g forgetting to take medicine), inability to access or pay for care, higher rates of smoking, poor diet, criminal victimization, and stigma. The most accurate answer indicates that seriously mentally ill people are at much higher risk of premature death for a variety of reasons. Staff would not have been surprised that the patient died prematurely, and they would not attribute his death to random, undetected medical problems. Although the cause of death will not be reliably established until the autopsy, this response fails to address the familys need for information.

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What is a common consequence of repeated purging behaviors in bulimia nervosa?

  • A. Cardiovascular instability due to electrolyte imbalances.
  • B. Improved body image and self-esteem.
  • C. Increased appetite and healthy weight gain.
  • D. Decreased risk of gastrointestinal complications.
Correct Answer: A

Rationale: The correct answer is A: Cardiovascular instability due to electrolyte imbalances. Repeated purging in bulimia nervosa leads to electrolyte imbalances, particularly hypokalemia, which can result in cardiovascular instability like arrhythmias and cardiac arrest. Other choices are incorrect. B is false as purging behaviors do not improve body image or self-esteem. C is incorrect as purging does not lead to increased appetite and healthy weight gain, rather it disrupts normal metabolism. D is also incorrect as purging behaviors actually increase the risk of gastrointestinal complications.

A patient with an eating disorder states, 'I heard people laughing behind me in the check-out line at the department store. I bet they thought it was hysterically funny that I gained a pound in the last few days.' The nurse documents that the patient is exhibiting which cognitive distortion related to maladaptive eating regulation responses?

  • A. Magnification
  • B. Personalization
  • C. Overgeneralization
  • D. Dichotomous thinking
Correct Answer: B

Rationale: The correct answer is B: Personalization. Personalization is a cognitive distortion where an individual takes responsibility for events that are not entirely their fault. In this scenario, the patient is attributing the laughter of people in the check-out line to being about them and their weight gain, when in reality, the laughter may have had nothing to do with them. This distortion can contribute to feelings of guilt, shame, and self-blame.

A: Magnification involves exaggerating the importance or meaning of an event, which is not evident in the scenario.
C: Overgeneralization involves making broad negative conclusions based on a single event, which is not demonstrated here.
D: Dichotomous thinking is the tendency to view situations in black and white terms, with no middle ground, which is not present in the patient's statement.

In most anxiety disorders, the person's distress is

  • A. focused on a specific situation
  • B. related to ordinary life stresses
  • C. greatly out of proportion to the situation
  • D. based on a physical cause
Correct Answer: C

Rationale: Anxiety disorders feature exaggerated distress disproportionate to the trigger, unlike normal stress.

A student transfers from a hometown college to a university 200 miles away after breaking up with her boyfriend of 2 years. She was slow to make friends at the university. The history shows a close relationship with her mother and sister. She began eating large quantities when she felt sad, and then she induced vomiting. When the student's schoolwork declined, she sought help. During the initial interview, what priority issue should the nurse address?

  • A. Losses.
  • B. Sleep patterns.
  • C. School activities.
  • D. None of the above.
Correct Answer: A

Rationale: The correct answer is A: Losses. The priority issue the nurse should address is the student's losses, such as the breakup with her boyfriend and the difficulty in making friends at the new university. This is important because these losses may be contributing to her emotional distress and maladaptive coping mechanisms like binge-eating and induced vomiting. The nurse needs to explore these losses to understand the root cause of the student's behavior and provide appropriate support.

Choice B: Sleep patterns, and Choice C: School activities are not the priority issues in this scenario. While sleep patterns and school activities are important aspects of the student's life, the primary concern here is addressing the emotional impact of the losses she has experienced.

Choice D: None of the above is incorrect because losses are indeed the priority issue that needs to be addressed in this situation. Ignoring the emotional impact of the student's losses could hinder the effectiveness of any interventions or support provided.

A nurse wants to assess for suicidal ideation in an elderly patient. Select the best question to begin this assessment.

  • A. Are there any things going on in your life that would cause you to consider suicide?'
  • B. What are your beliefs about a persons right to take his or her own life?'
  • C. Do you think you are vulnerable to developing a depressed mood?'
  • D. If you felt suicidal, would you tell someone about your feelings?'
Correct Answer: B

Rationale: This question is clear, direct, and respectful. It will produce information relative to the acceptability of suicide as an option to the patient. If the patient deems suicide unacceptable, no further assessment is necessary. If the patient deems suicide as acceptable, the nurse can continue to assess intent, plan, means to carry out the plan, lethality of the chosen method, and so forth. The other options are less direct, may produce responses that may be unclear, or are appropriate for later in this discussion.

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