Age Specific Patient Care

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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.

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The nurse working with a client whose diagnosis is bulimia asks the client to recall a time in her life when eating was a positive experience and she enjoyed small amounts of food without purging. The purpose of this intervention is to:

  • A. gain additional information about the client's bulimic condition.
  • B. emphasize that the client is capable of engaging in eating without purging.
  • C. incorporate specific foods into the meal plan to reflect pleasant memories.
  • D. assist the client to become more compliant with the treatment plan.
Correct Answer: B

Rationale: The correct answer, B, emphasizes that the client is capable of engaging in eating without purging. By asking the client to recall a positive experience with food, the nurse is helping the client recognize that they can enjoy food without the need to purge. This intervention aims to challenge the client's negative beliefs about food and eating, promoting a healthier relationship with food.

Choice A is incorrect as the purpose is not solely to gain additional information about the client's condition but rather to shift the client's perspective on food. Choice C is incorrect as the intervention focuses on emotional aspects rather than specific foods. Choice D is incorrect as the goal is to address the psychological aspect of the client's behavior, not just compliance with the treatment plan.

Statistical approaches to abnormality define as 'abnormal' those who

  • A. show evidence of loss of contact with reality
  • B. are unhappy, withdrawn, and depressed
  • C. deviate from typical or average patterns of behavior
  • D. are disabled by anxiety
Correct Answer: C

Rationale: Statistical definitions label behavior abnormal if it deviates significantly from the norm, regardless of specific symptoms.

A patient receiving risperidone (Risperdal) reports severe muscle stiffness midmorning. During lunch he has difficulty swallowing food and speaking, and when vital signs are taken 30 minutes later, he is noted to be stuporous and diaphoretic, with a temperature of 38.8° C, pulse of 110 beats/min, and blood pressure of 150/90 mm Hg. The nurse should suspect ______ and should ______.

  • A. neuroleptic malignant syndrome"¦place him in a cooling blanket and transfer to ICU
  • B. anticholinergic toxicity"¦check vital signs and prepare to use a cooling blanket stat
  • C. relapse of his psychosis"¦administer PRN antipsychotic drugs and notify his physician
  • D. agranulocytosis"¦hold his antipsychotic and draw blood for a complete blood count
Correct Answer: A

Rationale: The correct answer is A: neuroleptic malignant syndrome (NMS). The patient's symptoms align with NMS, a rare but serious side effect of antipsychotic medications like risperidone. The severe muscle stiffness, difficulty swallowing, altered mental status, diaphoresis, and elevated temperature, pulse, and blood pressure are all indicative of NMS. The nurse should suspect NMS and take immediate action by placing the patient in a cooling blanket to lower the temperature and transfer him to the ICU for close monitoring and further management.

Choice B is incorrect because anticholinergic toxicity typically presents with different symptoms such as dry mouth, dilated pupils, and confusion. Choice C is incorrect as there are no signs of a psychotic relapse, and administering more antipsychotic medication could worsen the NMS. Choice D is incorrect as agranulocytosis presents with symptoms like fever and sore throat, not the combination of symptoms seen in this case.

The nurse is assisting a victim of spousal abuse to create a plan for escape if it becomes necessary. What components should the plan include? Select all that apply.

  • A. A code word to signal children that it is time to leave.
  • B. Phone numbers for the nearest shelter and crisis hotline.
  • C. Telling the spouse that she has a plan and will leave.
  • D. Collecting birth certificates and other essential documents.
Correct Answer: A

Rationale: The correct answer is A: A code word to signal children that it is time to leave. This is crucial for ensuring the safety of the victim and their children without alerting the abuser. Other choices like B, providing phone numbers for shelters, are important but may not always be feasible in an emergency. Choice C, informing the spouse about the plan, can escalate the situation. Choice D, collecting essential documents, is important but may not always be the immediate priority in a dangerous situation. Having a code word ensures a discreet and quick escape if needed.

Sudden temporary amnesia or instances of multiple personality are disorders

  • A. dissociative
  • B. anxiety
  • C. psychotic
  • D. schizophrenic
Correct Answer: A

Rationale: Dissociative disorders include amnesia and multiple personalities, linked to identity disruption.

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