Population Based Health Care

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A patient was admitted to the mental health unit after arguing with co-workers and threatening to kill them. He is diagnosed with paranoid schizophrenia. On the unit he is aloof and suspicious. He mentioned that two physicians he saw talking were plotting to kill him. On the basis of data gathered at this point, which two primary nursing diagnoses should the nurse consider?

  • A. Disturbed thought processes and Risk for other-directed violence
  • B. Spiritual distress and Social isolation
  • C. Risk for loneliness and Knowledge deficit
  • D. Disturbed personal identity and Nonadherence
Correct Answer: A

Rationale: The correct answer is A: Disturbed thought processes and Risk for other-directed violence.

1. Disturbed thought processes: The patient's delusion of being plotted against by the physicians indicates impaired thought processes typical of paranoid schizophrenia.
2. Risk for other-directed violence: The patient's threatening behavior towards co-workers suggests a potential for violent acts towards others due to his paranoid beliefs.

Summary of why other choices are incorrect:
B: Spiritual distress and Social isolation are not primary concerns given the patient's acute symptoms of paranoia and risk for violence.
C: Risk for loneliness and Knowledge deficit are not crucial at this point as the patient's primary issues are related to paranoia and violence.
D: Disturbed personal identity and Nonadherence are not relevant to the immediate safety and mental health concerns presented by the patient.

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After assessing a patient with anorexia nervosa, a nurse writes the following nursing diagnosis: imbalanced nutrition, less than body requirements related to refusal to eat as evidenced by being 25% below body weight for height. The expected outcome should be listed as:

  • A. Patient will identify cognitive distortions about food, weight, and body shape.'
  • B. Patient will exhibit fewer signs of malnutrition within 2 weeks of hospitalization.'
  • C. Patient will be able to describe both the physical and emotional complications of the eating disorder.'
  • D. Patient will restore healthy eating patterns and normalize physiological parameters related to weight and nutrition.'
Correct Answer: D

Rationale: The correct answer is D because the expected outcome for a patient with imbalanced nutrition due to anorexia nervosa should focus on restoring healthy eating patterns and normalizing physiological parameters related to weight and nutrition. This outcome directly addresses the underlying issue of inadequate nutrition intake and helps the patient achieve a healthier state.

A: While identifying cognitive distortions is important for addressing the psychological aspects of anorexia nervosa, it does not directly address the patient's nutritional needs.
B: Exhibiting fewer signs of malnutrition is a vague outcome and does not specify how the patient will achieve this improvement.
C: Describing physical and emotional complications is informative but does not address the primary goal of improving nutrition intake and weight restoration.

A patient who has been physically abused says, 'When I called the police, I just wanted my spouse to stop shoving me around and kicking me. I didn't want anyone to get in trouble. It's easy to get angry with me because I spend too much money.' Which nursing intervention would be most therapeutic for this patient?

  • A. You feel your spouse was justified in the abuse because you overspent?'
  • B. Tell your spouse that if this happens again, I'll report it to the police.'
  • C. Your spouse abuses you when you overspend. So you think it will stop if you stop spending money?'
  • D. I can understand that you don't want to press charges, but your spouse needs help controlling anger.'
Correct Answer: A

Rationale: The correct answer is A because it focuses on therapeutic communication by reflecting the patient's feelings and thoughts back to them without judgment. By repeating the patient's words, the nurse shows empathy and understanding, which can help build trust and rapport. Choices B and D may escalate the situation and go against the patient's wishes, potentially causing further harm. Choice C assumes a causal relationship between overspending and abuse, which is not appropriate and may blame the victim. Overall, choice A promotes a non-judgmental and supportive environment, which is crucial in addressing issues of abuse.

Anorexia nervosa is best described as a disorder that is potentially:

  • A. serious.
  • B. uncommon.
  • C. psychiatric.
  • D. life threatening.
Correct Answer: D

Rationale: The correct answer is D: life threatening. Anorexia nervosa is a serious eating disorder characterized by extreme restriction of food intake, leading to significant weight loss and potentially life-threatening consequences such as organ damage, heart problems, and even death. It is crucial to recognize the severity of anorexia nervosa as it can have devastating effects on physical and mental health. Choices A and C are partially correct, as anorexia nervosa is serious and psychiatric, but they do not fully capture the potential severity and life-threatening nature of the disorder. Choice B is incorrect as anorexia nervosa is not uncommon, affecting a significant number of individuals worldwide.

A patient diagnosed with schizophrenia tells the community mental health nurse, 'I threw away my pills because they interfere with Gods voice.' The nurse identifies the etiology of the patients ineffective management of the medication regime as:

  • A. inadequate discharge planning
  • B. poor therapeutic alliance with clinicians
  • C. dislike of antipsychotic medication side effects
  • D. impaired reasoning secondary to the schizophrenia
Correct Answer: D

Rationale: The patients ineffective management of the medication regime is most closely related to impaired reasoning. The patient believes in being an exalted personage who hears Gods voice, rather than an individual with a serious mental disorder who needs medication to control symptoms. Data do not suggest any of the other factors often related to medication nonadherence.

A 45-year-old married woman who works full time in a factory has recently been absent for 3-day periods on several occasions. Each time, she returned to work wearing dark glasses. Facial and body bruises were apparent. Her supervisor became suspicious that she was a victim of battering and referred her to the occupational health nurse. What should the nurse first focus on as she meets the patient?

  • A. Notifying the police of the abuse
  • B. Documenting the woman's injuries
  • C. Establishing trust and building rapport
  • D. Collecting evidence to prosecute the abuser
Correct Answer: C

Rationale: The correct answer is C: Establishing trust and building rapport. The nurse should first focus on building a trusting relationship with the patient to create a safe environment for her to disclose any abuse she may be experiencing. By establishing trust and rapport, the nurse can gain the patient's confidence and encourage her to open up about her situation. This approach is crucial in ensuring the patient feels supported and empowered to seek help.

Incorrect choices:
A: Notifying the police of the abuse - This may jeopardize the patient's safety and could worsen the situation if she is not ready to involve law enforcement.
B: Documenting the woman's injuries - While documenting injuries is important, it should not be the first step as it may further distress the patient without addressing the underlying issue.
D: Collecting evidence to prosecute the abuser - Prosecution should not be the initial focus; the priority should be on the patient's well-being and safety.

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