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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 delusions (believing physicians are plotting to kill him) indicate disorganized thinking, a hallmark of paranoid schizophrenia.
2. Risk for other-directed violence: The patient's threatening behavior towards co-workers suggests a potential for violence towards others.
Incorrect choices:
B: Spiritual distress and Social isolation - Not directly related to the patient's current symptoms of paranoid delusions and threat of violence.
C: Risk for loneliness and Knowledge deficit - The patient's issues are more severe than loneliness or knowledge deficit.
D: Disturbed personal identity and Nonadherence - While these issues may be relevant in schizophrenia, they are not the primary concerns presented in this scenario.
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A nurse is caring for a patient with bulimia nervosa. What is the most important aspect of the treatment plan?
- A. To encourage purging behaviors to eliminate binge episodes.
- B. To provide a structured meal plan and monitor food intake.
- C. To focus solely on achieving weight loss.
- D. To offer therapy focused on body image without addressing eating behaviors.
Correct Answer: B
Rationale: The correct answer is B: To provide a structured meal plan and monitor food intake. This is crucial in the treatment of bulimia nervosa as it helps establish regular eating patterns, prevent binge episodes, and promote healthy nutrition. Providing structure and monitoring food intake also helps in addressing underlying psychological issues related to disordered eating. Encouraging purging behaviors (choice A) can worsen the condition and lead to serious health complications. Focusing solely on weight loss (choice C) may reinforce unhealthy behaviors and neglect the holistic approach needed for recovery. Offering therapy focused only on body image (choice D) overlooks the critical component of addressing eating behaviors and nutritional needs.
The mother of a 2-year-old tells the nurse at the well-child clinic that her child likes to take a blanket wherever he goes. The mother asks if she should take the blanket away from the child. The nurse counsels the mother to allow the child to have the blanket because it reminds him of his mother and comforts him. The basis for this counseling is:
- A. Mahler's theory of object relations
- B. Freud's developmental theory
- C. Kernberg's conceptualization object constancy
- D. Sullivan's theory of 'good me'
Correct Answer: A
Rationale: The correct answer is A: Mahler's theory of object relations. Mahler emphasizes the importance of transitional objects like a blanket for young children to provide comfort and security as they develop a sense of self and separation from their primary caregiver. This theory aligns with the situation described, where the child's attachment to the blanket symbolizes the bond with the mother.
Explanation for why the other choices are incorrect:
B: Freud's developmental theory focuses on psychosexual stages and the role of unconscious processes, not specifically on transitional objects.
C: Kernberg's conceptualization of object constancy pertains to personality disorders and object relations in adult psychotherapy, not child development.
D: Sullivan's theory of 'good me' is about interpersonal relationships and self-esteem, not directly related to transitional objects in child development.
A parent who is very concerned about a 3-year-old son says, 'He likes to play with girls' toys. Do you think he is homosexual or mentally ill?' Which response by the nurse most professionally describes the current understanding of gender identity?
- A. A child's interest in the activities of the opposite gender is not unusual or related to sexuality. Most children do not carry cross-gender interests into adulthood.
- B. It's difficult to say for sure because the research is incomplete so far, but chances are that he will grow up to be a normal adult.
- C. The research is incomplete, but many boys play with girls' toys and turn out normal as adults.
- D. I am sure that whatever happens, he will be a loving son, and you will be a proud parent.
Correct Answer: A
Rationale: The correct answer is A because it accurately reflects the current understanding of gender identity. Children's interests in activities typically associated with the opposite gender are not unusual and are not indicative of sexual orientation or mental illness. Most children who exhibit cross-gender interests do not carry these into adulthood. This response emphasizes the normalcy of such behavior and provides reassurance to the parent.
Choice B is incorrect because it implies uncertainty based on incomplete research, which goes against the established understanding that cross-gender interests in childhood are common and not predictive of future outcomes.
Choice C is incorrect because it focuses on incomplete research and uses the term "normal as adults," which can perpetuate stigmas surrounding gender expression.
Choice D is incorrect because it does not address the parent's concerns about the child's behavior and does not provide accurate information about gender identity development.
Which data gathered from the assessment of a family with a schizophrenic member would be of greatest importance in discharge planning for the patient?
- A. The patient is the middle sibling.
- B. The patient's mother is a talented artist.
- C. The patient's paternal grandfather was considered 'eccentric.'
- D. The patient becomes anxious when family members are critical of one another.
Correct Answer: D
Rationale: The correct answer is D because understanding how the patient reacts to family dynamics is crucial for discharge planning. Anxiety triggered by family conflict can impact the patient's well-being post-discharge. Choices A, B, and C are less relevant as they do not directly address the patient's immediate needs or potential stressors. Middle sibling status, maternal artistic talent, and paternal grandfather's eccentricity are interesting but not as directly impactful on the patient's discharge planning compared to the patient's response to family conflicts.
A patient with antisocial personality disorder tells Nurse A, 'You're a much better nurse than Nurse B said you were.' The patient tells Nurse B, 'Nurse A's upset with you for some reason.' To Nurse C the patient states, 'You'd like to think you're perfect, but I've seen three of your mistakes this morning.' These comments can best be assessed as:
- A. seductive.
- B. detached.
- C. guilt producing.
- D. manipulative.
Correct Answer: D
Rationale: The correct answer is D: manipulative. The patient is using different strategies to manipulate each nurse's emotions and behavior for personal gain. In the first scenario, the patient is attempting to create a divide between Nurse A and Nurse B by praising Nurse A and implying Nurse B's incompetence. In the second scenario, the patient is trying to instigate conflict between Nurse A and Nurse B by falsely suggesting Nurse A's negative feelings towards Nurse B. In the third scenario, the patient is employing a manipulative tactic by undermining Nurse C's confidence and competence. These behaviors demonstrate a pattern of manipulation aimed at controlling and influencing the nurses' perceptions and actions. Choices A, B, and C do not accurately capture the manipulative intent behind the patient's actions.