Age Specific Care

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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 client with an eating disorder that has resulted in weight loss to a point 15% below normal weight tells the nurse, 'I don't need to be hospitalized. I can control myself.' The nurse continues to prepare the client for hospitalization because the vicious cycle of eating disorder behavior is fueled by:

  • A. feelings of power and control resulting from weight loss.
  • B. dysfunctional family dynamics.
  • C. faulty use of the defense mechanism projection.
  • D. lack of superego constraints on behavior.
Correct Answer: A

Rationale: The correct answer is A: feelings of power and control resulting from weight loss. In clients with eating disorders, the behavior is often driven by a sense of control and power gained through weight loss. This reinforces the cycle of the disorder as the individual feels empowered by their ability to restrict food intake. This false sense of control becomes a driving force in the continuation of the disorder.

Incorrect answers:
B: Dysfunctional family dynamics may contribute to the development of an eating disorder, but in this scenario, the client's refusal for hospitalization is more related to their own sense of control rather than family dynamics.
C: Faulty use of the defense mechanism projection is not the primary reason for the client's resistance to hospitalization in this case.
D: Lack of superego constraints on behavior is not the main factor driving the client's refusal for hospitalization.

What is the primary nursing concern for a patient with anorexia nervosa during the early stages of treatment?

  • A. Ensuring rapid weight gain to restore health.
  • B. Addressing the patient's psychological issues related to body image.
  • C. Maintaining nutritional intake to prevent further weight loss.
  • D. Promoting self-esteem and body image satisfaction.
Correct Answer: C

Rationale: The primary nursing concern for a patient with anorexia nervosa in the early stages of treatment is maintaining nutritional intake to prevent further weight loss. This is crucial as malnutrition can lead to serious health complications. Ensuring adequate nutrition supports physical health and provides a foundation for addressing psychological issues in later stages of treatment. Rapid weight gain (A) can be harmful and lead to refeeding syndrome. Addressing psychological issues (B) and promoting self-esteem (D) are important but secondary concerns once nutritional stability is achieved.

In the elderly, administering medication is a great concern for the nurse since these patients are more prone to side effects. The primary cause of this is:

  • A. Altered circulation and renal function
  • B. Accelerated gastrointestinal system
  • C. Enlarged Lymph nodes
  • D. Musculoskeletal system weakness
Correct Answer: A

Rationale: The elderly are more likely to have side effects when there is altered metabolism through the kidneys and liver as well as altered circulatory function (A), unlike the other options (B, C, D) which are less relevant.

When a patient with anorexia nervosa is admitted for treatment, the milieu should provide: (Select all that apply.)

  • A. Flexible mealtimes.
  • B. Unscheduled weight checks.
  • C. Adherence to a selected menu.
  • D. None of the above.
Correct Answer: A

Rationale: The correct answer is A: Flexible mealtimes. In the treatment of anorexia nervosa, providing flexible mealtimes allows patients to regain a sense of control over their eating habits, which is crucial in their recovery process. This approach helps to reduce anxiety around food and promotes a healthier relationship with eating.

Choice B: Unscheduled weight checks can be triggering and anxiety-provoking for patients with anorexia nervosa, as weight monitoring can be a significant source of distress for them.

Choice C: Adherence to a selected menu may reinforce rigid eating patterns and control issues related to food, which can be counterproductive in the treatment of anorexia nervosa.

Choice D: None of the above is incorrect because providing flexible mealtimes is essential in creating a supportive and therapeutic environment for patients with anorexia nervosa.

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