Nokea
A patient is noted to be bending over backward in the group room. A peer asks what he is doing, and he replies, 'People say they are bending over backwards to help me, so I am bending over backwards to help myself.' This is an example of:
- A. abstract thinking.
- B. concrete thinking.
- C. impaired reality testing.
- D. boundary impairment.
Correct Answer: B
Rationale: The correct answer is B: concrete thinking. Concrete thinking refers to interpreting things in a literal or straightforward manner without grasping abstract concepts or metaphors. In this scenario, the patient is taking the expression "bending over backward" literally, demonstrating a lack of understanding of its figurative meaning.
A: Abstract thinking involves understanding complex concepts and interpreting information beyond the literal meaning. The patient's response does not demonstrate abstract thinking.
C: Impaired reality testing refers to an inability to distinguish between what is real and what is not. The patient's response does not suggest a detachment from reality.
D: Boundary impairment involves difficulty in recognizing and maintaining personal boundaries. The patient's response does not relate to boundary issues.
In summary, the patient's literal interpretation of the expression "bending over backward" reflects concrete thinking, making choice B the correct answer.
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A patient moving from chair to chair in the day room and pacing in the hallway repeatedly, rapidly, and for extended periods is likely demonstrating ______, and the nurse should ______.
- A. a dystonic reaction"¦administer PRN IM benztropine (Cogentin)
- B. anxiety"¦ teach and guide the patient to use relaxation exercises
- C. akathisia"¦administer PRN diphenhydramine (Benadryl) PO
- D. tardive dyskinesia"¦recommend a change in medication
Correct Answer: C
Rationale: The correct answer is C: akathisia"¦administer PRN diphenhydramine (Benadryl) PO. Akathisia is characterized by restlessness and an inability to sit still. Administering diphenhydramine can help alleviate these symptoms. A is incorrect because dystonic reactions present with muscle spasms and abnormal postures, not restlessness. B is incorrect as anxiety does not typically manifest as physical restlessness. D is incorrect as tardive dyskinesia involves involuntary movements of the face and body, not restlessness.
A client has been diagnosed with a dementia secondary to cerebral disease. The family members note the client 'has not been as sharp as he once was' and that he has developed urinary incontinence and a gait disturbance. They attributed the first symptom to normal aging but were alarmed by the latter two symptoms. Based on this history, which of the following should come to mind?
- A. Normal pressure hydrocephalus
- B. Vitamin B12 deficiency
- C. Hepatic disease
- D. Tuberculosis
Correct Answer: A
Rationale: Step 1: The client presents with urinary incontinence and a gait disturbance, suggestive of normal pressure hydrocephalus (NPH) due to cerebral disease.
Step 2: NPH is characterized by the triad of cognitive decline, gait disturbances, and urinary incontinence.
Step 3: Symptoms of NPH can mimic normal aging but are distinct from other conditions.
Step 4: Vitamin B12 deficiency (B) primarily presents with anemia and neurological symptoms, not the triad seen in NPH.
Step 5: Hepatic disease (C) typically presents with symptoms related to liver dysfunction, not the triad of NPH.
Step 6: Tuberculosis (D) manifests with respiratory symptoms and constitutional symptoms, not the cognitive decline and gait issues seen in NPH.
A client admitted with delusions, hallucinations, and thought disorder has the admitting diagnosis schizophreniform disorder R/O organic pathology. Based on this information, the nurse can expect that the client will:
- A. Undergo an MRI test
- B. Have psychological testing
- C. Have an immunologic assay performed
- D. Participate in a dexamethasone suppression test
Correct Answer: A
Rationale: Step 1: The client is admitted with symptoms suggestive of a psychotic disorder, specifically schizophreniform disorder.
Step 2: The admitting diagnosis includes ruling out organic pathology, indicating a need to investigate potential physical causes.
Step 3: An MRI test is a non-invasive imaging procedure that can help identify any structural abnormalities in the brain.
Step 4: This test is appropriate in ruling out organic causes of the symptoms presented by the client.
Step 5: Psychological testing (Choice B) is more focused on assessing cognitive and emotional functioning, not ruling out organic pathology.
Step 6: Immunologic assay (Choice C) is used to detect antibodies or antigens in the blood, not typically relevant in this context.
Step 7: Dexamethasone suppression test (Choice D) is used to assess for abnormalities related to cortisol levels in conditions like depression, not specific to ruling out organic pathology in psychotic disorders.
Summary: Choice A is correct because an MRI test is the most relevant
A patient tells a nurse, 'The others won't give me my pain meds early, but you are more understanding, you know what it's like to be in pain, and you don't want to see your patients suffer. Could you find a way to get me my pill now? I won't tell anyone.' Which response by the nurse would be most therapeutic?
- A. I'm not comfortable doing that,' then ignore subsequent requests for early meds.
- B. I'll have to check with your doctor about that; I will get back to you after I do.'
- C. It would be unsafe to give the medicine early; none of us will do that.'
- D. I understand that you have pain, but giving medicine too soon would not be safe.'
Correct Answer: D
Rationale: Rationale:
- Choice D is the correct response because it acknowledges the patient's pain, shows empathy, and educates on the importance of safe medication administration.
- Step 1: Acknowledge the patient's pain to validate their feelings.
- Step 2: Express understanding but emphasize safety concerns to educate the patient on responsible medication use.
- Step 3: Maintain boundaries by emphasizing the importance of safe medication practices.
- Other Choices:
- A: Ignoring the patient's request can create distrust and may not address the underlying issue of pain management.
- B: Delaying the response by involving the doctor may increase the patient's anxiety and does not address the safety concern.
- C: Simply stating that it is unsafe without providing further explanation or addressing the patient's concerns lacks empathy and education.
A patient with borderline personality disorder has been hospitalized several times after self-injurious behavior and suicide attempts. The patient has entered dialectical behavior therapy on an outpatient basis. During therapy, the advanced practice nurse has been counseling her regarding self-harm behavior management. Today the patient called the nurse and reported 'feeling empty and anxious' and wants to cut herself. Which response would best help in this situation?
- A. Arrange for an emergency admission to a crisis unit.
- B. Arrange for an emergency admission to an inpatient unit.
- C. Assist the patient to identify and choose a coping strategy.
- D. Advise the patient to take an anxiolytic, then go to sleep.
Correct Answer: C
Rationale: The correct response is C: Assist the patient to identify and choose a coping strategy. This choice is the best because it involves helping the patient develop healthy coping mechanisms to manage her distress. This empowers the patient to take control of her emotions and actions in a positive way. Emergency admissions (choices A and B) may not address the underlying issues and could potentially reinforce maladaptive behaviors. Advising medication (choice D) without addressing the emotional distress directly may not provide long-term solutions. In summary, choice C focuses on empowering the patient and addressing the root of the problem, making it the most appropriate response in this scenario.