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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 indicate a lack of remorse or guilt about committing Medicare fraud. He minimizes his actions and justifies them by blaming the government's rules. This demonstrates a lack of ethical responsibility and empathy for the consequences of his fraudulent behavior.
A: Glibness and charm typically involve being smooth-talking and charismatic, which is not evident in the therapist's statements.
B: Superficial remorse would imply some level of acknowledgment of wrongdoing, which is not present in the therapist's justifications.
D: Excessive suspiciousness refers to unfounded mistrust or paranoia, which is not demonstrated in the therapist's statements.
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A Hispanic woman comes to the mental health center at the urging of her adult children. The patient has lost 5 pounds since her husband's death 6 months ago and says, "My husband comes to visit me in the night but I cannot understand what he says." How should the nurse analyze this situation? The patient is:
- A. Experiencing auditory and visual hallucinations.
- B. At high risk for imbalanced nutrition.
- C. Grieving the husband's death.
- D. Denying the husband's death.
Correct Answer: C
Rationale: The correct answer is C: Grieving the husband's death. The patient's statement about her deceased husband visiting her in the night and her weight loss following his death indicate a strong possibility of experiencing grief. This is a common manifestation of bereavement, where individuals may have difficulty accepting the reality of the loss and experience hallucinations or illusions involving the deceased. The patient's symptoms are more aligned with the normal process of grieving rather than psychosis. Choices A and B are incorrect because the patient's experiences are likely related to grief rather than auditory and visual hallucinations or imbalanced nutrition. Choice D is incorrect as the patient's statements suggest she is aware of her husband's death but is struggling to cope with it emotionally.
An elderly female client on the mental unit suddenly becomes upset because she can't remember where she is and she says, 'I can't think straight.' The staff has never witnessed this behavior in the client, and this type of complaint is not documented in the nursing history. What is the client most likely experiencing?
- A. Hallucinations
- B. Dementia
- C. Delusions
- D. Delirium
Correct Answer: D
Rationale: The correct answer is D: Delirium. Delirium is characterized by sudden onset confusion, disorientation, and impaired cognitive function. In this scenario, the elderly client's sudden confusion and inability to think straight suggest an acute change in mental status, which is indicative of delirium. Delirium is often triggered by underlying medical conditions or medications.
A: Hallucinations involve perceiving things that are not real, which is not described in the scenario.
B: Dementia is a chronic condition with gradual cognitive decline, not sudden onset confusion.
C: Delusions are fixed false beliefs, which are not mentioned in the scenario.
In summary, the client is most likely experiencing delirium due to the sudden onset of confusion and cognitive impairment, which is not consistent with hallucinations, dementia, or delusions.
A client with undifferentiated schizophrenia is readmitted for an acute exacerbation of the disorder. The goal of hospitalization is symptom stabilization. The nurse has documented that, in addition to experiencing auditory hallucinations, the client seems uninterested in activities, has difficulty completing tasks, seems forgetful, and seems puzzled by information and directions given by staff. The nurse's plans for intervention will be effective if these behaviors are attributed to:
- A. Social isolation
- B. Deficient knowledge
- C. Situational low self-esteem
- D. Problems in cognitive functioning
Correct Answer: D
Rationale: The correct answer is D: Problems in cognitive functioning. In undifferentiated schizophrenia, cognitive deficits are common, leading to difficulties in memory, attention, problem-solving, and executive functioning. The client's symptoms of forgetfulness, difficulty completing tasks, being puzzled by information, and auditory hallucinations are indicative of cognitive impairment. Interventions should focus on addressing these cognitive deficits to improve the client's ability to function.
Incorrect choices:
A: Social isolation - This choice does not address the cognitive deficits and symptoms described by the client, such as forgetfulness and difficulty completing tasks.
B: Deficient knowledge - While cognitive deficits may contribute to deficient knowledge, the primary concern in this scenario is the client's cognitive functioning impairments.
C: Situational low self-esteem - This choice does not explain the cognitive deficits and symptoms experienced by the client, which are more indicative of problems in cognitive functioning.
A nurse is working with a patient with bulimia nervosa. Which outcome would indicate successful intervention?
- A. The patient eats three full meals daily without purging.
- B. The patient agrees to begin psychotherapy without resistance.
- C. The patient loses 5% of their body weight over 3 months.
- D. The patient expresses improved body image but still purges occasionally.
Correct Answer: A
Rationale: The correct answer is A because it indicates successful intervention in bulimia nervosa by demonstrating healthy eating behavior without purging. This outcome reflects improved control over binge-purge cycles and supports physical health. Choices B and D show progress but do not directly address the core issue of purging behavior. Choice C, losing weight, can be a misleading indicator and may not necessarily reflect improved psychological and behavioral outcomes associated with recovery from bulimia nervosa.
Why did the risk of acquiring disease decrease for people living in cities since the 1850's?
- A. The 'sanitation revolution' improved the water supplies
- B. Urban residents received more regular vaccinations
- C. Antibiotics were more readily used
- D. All of the above
Correct Answer: D
Rationale: The sanitation revolution, along with vaccinations and antibiotics, collectively reduced disease risk in cities since the 1850s.