Population Based Health 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.' Which nursing intervention would be most helpful for addressing this behavior?

  • A. Hold a weekly staff meeting to discuss feelings and conflicts related to such behavior.
  • B. Confront the patient and advise her that if she continues this, she will lose privileges.
  • C. Get all staff to agree that any and all inappropriate behavior will simply be ignored.
  • D. Evaluate the patient for a medication increase or transfer to a long-term facility.
Correct Answer: A

Rationale: The correct answer is A: Hold a weekly staff meeting to discuss feelings and conflicts related to such behavior. This intervention promotes open communication among staff members to address and understand the patient's behavior. It allows for collaboration in managing challenging situations and ensures consistency in approach. Confronting the patient (B) may escalate the behavior and damage the therapeutic relationship. Ignoring inappropriate behavior (C) does not address the underlying issues and may lead to staff frustration. Evaluating for medication increase or transfer (D) should be considered only after non-pharmacological interventions have been exhausted.

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A severely depressed patient with psychomotor retardation has begun activities therapy. His schedule is: 9 AM, ceramics; 10 AM, exercise group; 11 AM to noon, open; noon, lunch. The nurse creating the patient's schedule should opt to fill the hour block from 11 AM to noon with:

  • A. Group therapy.
  • B. A rest period.
  • C. Reminiscence group.
  • D. Individual counseling.
Correct Answer: B

Rationale: The correct answer is B: A rest period. Providing a rest period during the hour block from 11 AM to noon is crucial for a severely depressed patient with psychomotor retardation. This patient may experience fatigue and decreased energy levels due to their condition. Allowing for a rest period can help prevent overstimulation and promote relaxation, which is essential for mental well-being. Group therapy (choice A) may be too overwhelming for the patient at this time. Reminiscence group (choice C) may not be as beneficial for immediate symptom management. Individual counseling (choice D) may be helpful but may not align with the patient's immediate need for rest and relaxation.

When coping with a patient's inappropriate expression of anger, a psychiatric-mental health nurse's initial action is to identify the:

  • A. appropriate limit-setting techniques
  • B. nurse's own response to the anger
  • C. patient's specific defense mechanisms
  • D. systems theory for effecting change
Correct Answer: B

Rationale: Understanding the nurse's own emotional response ensures objectivity and effective management of the patient's anger.

Which of the following will lead one to need to consider autism spectrum disorder as a likely diagnosis?

  • A. A girl spoke her first words at 14 months, enjoyed playing with Peppa Pig characters at age 2 daily. She tended to sit away from her classmates at recess at age 7 but when asked, would say she had 30 friends. She was very good at the piano and had strong knowledge of all the great composers at age 8. She entered the Gifted Education Programme at 10. At 13, she did poorly at group work, often talked about death and the afterlife, and became progressively silent
  • B. A boy walked at 18 months, spoke his first words at 2 , and enjoyed playing Minecraft at 4 together with his friends. He participated at birthday parties. He struggled with composition writing, both for ideas and also for the efforts in writing in school, but managed an AL score of 18 and was promoted to secondary school
  • C. A boy walked at 13 months and was a happy child in preschool. He started speaking at 18 months but did not recognise letters and numbers consistently until 4.5 years of age. He did not read until 7 . He was sometimes forgetful with instructions but did not cause disruption in school, though he was often the clown in class. He tended to not finish his work unless his parents sat with him. Nonetheless, he completed primary school with some extra time for exams and went on to secondary school
  • D. A girl walked at 16 months and was often clumsy though she did not fall. She would bump into things and might drop items in her hands. She disliked writing and was slow to write. She could never complete her work in class. She would shade the wrong answers on the optical answer sheet although she knew the right answers. She had trouble with mathematics thoughout school but she enjoyed reading
Correct Answer: A

Rationale: Option A shows social withdrawal, poor group interaction, and restricted interests (music, death themes), aligning with ASD criteria in DSM-5, unlike the others with more typical development or specific learning/motor issues.

The federal act that establishes the standards of care for older adults is known as the Omnibus Budget Act.

  • A. Reconciliation
  • B. Budget
  • C. Care
  • D. Standards
Correct Answer: A

Rationale: The Omnibus Budget Reconciliation Act (OBRA) (A) ensures that proper assessment of elderly people will be provided in the health care facility and in the home, as per its full name.

The daughter of an 84-year-old client with dementia tearfully tells the nurse that she doesn't know what's wrong with her mother, who has begun accusing the family of stealing her lingerie and holding her prisoner. The nurse assesses the client's stage of Alzheimer's disease as stage:

  • A. 1
  • B. 2
  • C. 3
  • D. 4
Correct Answer: B

Rationale: The correct answer is B (stage 2) because the client is exhibiting symptoms of moderate Alzheimer's disease, such as paranoia and delusions. In stage 2, cognitive decline becomes more noticeable, leading to memory loss, confusion, and behavioral changes. The client's accusations and false beliefs indicate a decline in reality orientation, which is characteristic of stage 2. Choices A, C, and D are incorrect because stage 1 is characterized by mild cognitive decline, stage 3 by severe cognitive decline, and stage 4 by very severe cognitive decline.

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