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A patient remanded by the court after his wife had him jailed for battery told the judge how sorry he was and suggested he needed psychiatric help. His history reveals acting-out behaviors as an adolescent and several adult arrests. The nurse interviews him about his relationship with his wife. Which statement by the patient is most consistent with a diagnosis of antisocial personality disorder?
- A. I've done some stupid things in my life, but I've learned a lesson.'
- B. I'm feeling terrible about the way my behavior has hurt my family.'
- C. I have a quick temper, but I can usually keep it under control.'
- D. I hit her because she nags at me. She deserves it when I beat her up.'
Correct Answer: D
Rationale: The correct answer is D. This statement reflects a lack of remorse, empathy, and justification for violent behavior, which are key characteristics of antisocial personality disorder. The patient blames his wife for his violent actions and shows a sense of entitlement.
A: This statement shows acknowledgment of mistakes and a willingness to learn from them, which is not consistent with antisocial personality disorder.
B: Expressing feeling terrible about hurting family members demonstrates some level of empathy and remorse, which is not typical of individuals with antisocial personality disorder.
C: Acknowledging a quick temper but being able to control it does not align with the impulsivity and lack of control often seen in individuals with antisocial personality disorder.
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A nurse has completed the assessment for a patient who has a maladaptive response to eating regulation. Findings include the following: height, 5 feet 3 inches; current weight, 80 pounds with weight loss of 30% of body weight over the past 3 months; T, 96.6m F; BP, 68/40; P, 40; R, 20; poor skin turgor; lanugo; amenorrhea of 6 months' duration; admits to restricting intake to 350 calories daily; dissatisfied with eating pattern as evidenced by patient statement, 'I need to lose another 10 pounds to be at an ideal weight.' These assessment findings are most consistent with the medical diagnosis of:
- A. bulimia nervosa.
- B. anorexia nervosa.
- C. binge-eating disorder.
- D. disturbed body image.
Correct Answer: B
Rationale: The correct answer is B: Anorexia nervosa. The assessment findings align with the diagnostic criteria for anorexia nervosa, including significant weight loss, restrictive eating patterns, distorted body image, amenorrhea, and physical signs like poor skin turgor and lanugo. The patient's extreme weight loss, restrictive calorie intake, dissatisfaction with weight despite being underweight, and other physical and psychological symptoms are classic indicators of anorexia nervosa.
Incorrect Choices:
A: Bulimia nervosa involves binge eating followed by compensatory behaviors, which are not evident in this case.
C: Binge-eating disorder involves recurrent episodes of binge eating without compensatory behaviors, which are not present here.
D: Disturbed body image may be present in anorexia nervosa, but the key features of weight loss, restrictive eating, and amenorrhea are more indicative of anorexia nervosa.
A woman tells the nurse that her husband abuses her most often when he is intoxicated, just as his father had beaten him and his mother. The woman is aware of the location of a safe house and has considered leaving home with her two children, but she cites being brought up to believe 'you keep quiet and stay together, no matter what happens.' She states the husband is always apologetic and remorseful after an incident. What evidence exists that the husband is at risk of becoming a perpetrator of physical abuse? He:
- A. is unable to make lasting behavioral changes.
- B. was an abused child.
- C. is without a job.
- D. experiences remorse.
Correct Answer: B
Rationale: The correct answer is B because the husband's history of being abused as a child increases his risk of becoming a perpetrator of physical abuse. Research shows that individuals who have been abused are more likely to perpetrate abuse themselves. This is due to a cycle of violence where behaviors learned in childhood are repeated in adulthood. In this case, the husband's abusive behavior towards his wife mirrors his own upbringing where his father abused his mother. This pattern suggests that the husband may continue the cycle of abuse.
Choice A (is unable to make lasting behavioral changes) is incorrect because it does not directly correlate with the risk of becoming a perpetrator of physical abuse. Choice C (is without a job) is also incorrect as employment status does not necessarily indicate a propensity for abuse. Choice D (experiences remorse) is incorrect as feeling remorse after abusive incidents does not negate the risk of becoming a perpetrator of physical abuse.
A nurse is caring for a patient with bulimia nervosa. The nurse should monitor for which of the following complications?
- A. Nutritional deficiency and dehydration.
- B. Respiratory failure and aspiration pneumonia.
- C. Peripheral edema and hyperkalemia.
- D. Mental confusion and decreased blood pressure.
Correct Answer: A
Rationale: The correct answer is A: Nutritional deficiency and dehydration. In bulimia nervosa, recurrent episodes of binge eating followed by purging can lead to electrolyte imbalances, dehydration, and malnutrition. Monitoring for nutritional deficiencies and dehydration is crucial in managing patients with bulimia nervosa.
Explanation for why other choices are incorrect:
B: Respiratory failure and aspiration pneumonia - Although purging behaviors can increase the risk of aspiration pneumonia, it is not as common as nutritional deficiencies and dehydration in patients with bulimia nervosa.
C: Peripheral edema and hyperkalemia - These complications are not typically associated with bulimia nervosa.
D: Mental confusion and decreased blood pressure - While electrolyte imbalances can lead to mental confusion, these specific complications are not as common as nutritional deficiencies and dehydration in patients with bulimia nervosa.
Which statements most clearly indicate the speaker views mental illness with stigma? Select one tha does not apply.
- A. We are all a little bit crazy.'
- B. If people with mental illness would go to church, their problems would be solved.'
- C. Many mental illnesses are genetically transmitted. Its no ones fault that the illness occurs.'
- D. People with mental illness are lazy. They get government disability checks instead of working.'
Correct Answer: C
Rationale: Stigma is represented by judgmental remarks that discount the reality and validity of mental illness. It is evidenced in stereotypical statements, by oversimplification, and by multiple other messages of guilt or shame.
A patient experiencing delirium secondary to corticosteroid toxicity is manifesting paranoid thinking and noisy, assaultive behavior. The patient is currently pacing the hall and shouting. A nurse has placed a call to the physician and is anticipating the following order:
- A. the use of supervised restraints.
- B. a loading dose of phenytoin.
- C. a small dose of prednisone.
- D. an IV dose of thiamine.
Correct Answer: A
Rationale: The correct answer is A: the use of supervised restraints. In this situation, the patient is displaying agitated and assaultive behavior, posing a risk to themselves and others. Supervised restraints are necessary to ensure the safety of the patient and healthcare providers until the effects of corticosteroid toxicity subside. Restraints should only be used as a last resort when other interventions have failed.
Choice B: A loading dose of phenytoin is incorrect because phenytoin is not indicated for managing delirium secondary to corticosteroid toxicity.
Choice C: A small dose of prednisone is incorrect because adding more corticosteroids would exacerbate the toxicity and worsen the delirium.
Choice D: An IV dose of thiamine is incorrect as thiamine is used to treat thiamine deficiency, not corticosteroid toxicity-induced delirium.