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A physical therapist recently convicted of multiple counts of Medicare fraud is brought to the emergency department after taking an overdose of sedatives. He tells the nurse, 'Sure I overbilled. Why not? Everybody takes advantage of the government. They have too many rules. No one can abide by all of them.' These statements can be assessed as showing:

  • A. glibness and charm.
  • B. superficial remorse.
  • C. lack of guilt feelings.
  • D. excessive suspiciousness.
Correct Answer: C

Rationale: The correct answer is C: lack of guilt feelings. The physical therapist's statements reveal a lack of remorse or guilt for committing Medicare fraud, indicating a disregard for ethical standards and a lack of moral responsibility. This behavior is indicative of a lack of guilt feelings, as the individual shows no remorse for their actions.

Summary of other choices:
A: Glibness and charm typically involve smooth talking and being persuasive, which is not demonstrated in the scenario.
B: Superficial remorse implies a shallow or insincere apology, but the individual does not express any form of remorse in this situation.
D: Excessive suspiciousness refers to being overly mistrustful or paranoid, which is not evident in the physical therapist's statements.

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While the nurse at the personality disorders clinic is interviewing a patient, the patient constantly scans the environment and frequently interrupts to ask what the nurse means by certain words or phrases. The nurse notes that the patient is very sensitive to the nurse's nonverbal behavior. His responses are often argumentative, sarcastic, and hostile. He suggests that he is being hospitalized 'so they can exploit me.' The patient's behaviors are most consistent with the clinical picture of:

  • A. paranoid personality disorder.
  • B. histrionic personality disorder.
  • C. avoidant personality disorder.
  • D. narcissistic personality disorder.
Correct Answer: A

Rationale: The correct answer is A: paranoid personality disorder. The patient's behaviors align with the diagnostic criteria for paranoid personality disorder, characterized by suspicion, distrust, sensitivity to criticism, and interpreting benign interactions as threatening. The patient's constant scanning of the environment, interrupting to clarify meanings, being sensitive to nonverbal cues, and displaying argumentative and hostile responses are all indicative of paranoid traits. Additionally, the belief that hospitalization is for exploitation is consistent with paranoid beliefs.

Choices B, C, and D can be ruled out:
B: Histrionic personality disorder is characterized by attention-seeking behavior, emotional instability, and dramatic expression. The patient's behaviors are not suggestive of seeking attention or being overly dramatic.
C: Avoidant personality disorder is marked by social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation. The patient's behaviors are more indicative of suspiciousness rather than avoidance.
D: Narcissistic personality disorder involves grandiosity, need for admiration, and lack of

What behavior signals that a nurse caring for a patient with bulimia nervosa is experiencing rescue feelings? The nurse:

  • A. Makes nonjudgmental comments.
  • B. Refers the patient to a self-help group for persons with eating disorders.
  • C. Teaches the patient about signs of increased anxiety and ways to intervene.
  • D. Determines the patient has poor eating habits and provides a diet to follow.
Correct Answer: D

Rationale: The correct answer is D because providing a diet to follow indicates a rescuer mentality, where the nurse is assuming the role of fixing the patient's eating habits without addressing the underlying emotional issues. A, B, and C focus on supportive and empowering approaches which are more appropriate for helping the patient with bulimia nervosa.

A patient with schizophrenia begins to talk about creatures called 'volmers' hiding in the warehouse where he works and undoing his work each night. The term 'volmers' most likely represents:

  • A. a neologism.
  • B. clanging.
  • C. anhedonia.
  • D. alogia.
Correct Answer: A

Rationale: The correct answer is A: a neologism. In schizophrenia, patients often create new words (neologisms) that have no meaning outside of their delusional context. The term 'volmers' is a made-up word by the patient, indicating a loss of touch with reality. Clanging (B) is a speech pattern characterized by rhyming or punning words, not creating new words. Anhedonia (C) refers to the inability to experience pleasure, unrelated to creating new words. Alogia (D) is a decrease in speech or thought productivity, not related to inventing new words. In this case, the patient's use of 'volmers' is indicative of a neologism associated with schizophrenia.

Early manifestation of symptoms such as severe impairment in social interaction and in communication can be diagnosed as which of the following?

  • A. Infantile autism
  • B. Infantile amnesia
  • C. Cerebral palsy
  • D. Rett's syndrome
Correct Answer: A

Rationale: Infantile Autism: Early manifestations of Autistic Disorder symptoms, including impaired social interaction and communication.

A 17-year-old patient with anorexia nervosa has just been released from the hospital. To facilitate recovery at home, the psychiatric-mental health nurse instructs the family to:

  • A. discourage the patient from sneaking food between meals, by unobtrusively reducing access to the kitchen
  • B. encourage the patient's interest in menu planning, food magazines, and cooking lessons, by leaving information and materials around the house
  • C. permit the patient to eat her meals privately to discourage family preoccupation with meals
  • D. recommend that the patient joins in routine family meals and clears the dishes after dinner, even if they do not eat
Correct Answer: D

Rationale: Involving the patient in family meals normalizes eating behavior and provides structure, supporting recovery without enabling secrecy or avoidance.

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