Age Specific Considerations in Patient Care

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A severely withdrawn patient diagnosed with schizophrenia will spend time in the dayroom but will not speak to staff or to other patients. The most therapeutic nursing intervention in response to this behavior would be to:

  • A. seat the patient with a group of patients who are talking to each other.
  • B. ignore the silence and talk about superficial topics such as the weather.
  • C. point out that the patient makes others uncomfortable by refusing to speak.
  • D. plan time for staff members to sit with the patient even though the patient does not talk with them.
Correct Answer: D

Rationale: The correct answer is D because it focuses on building a therapeutic relationship with the patient without placing pressure on them to speak. By planning time for staff members to sit with the patient, even if the patient does not talk, it allows for nonverbal communication and presence to convey support and care. This approach respects the patient's boundaries and allows them to engage at their own pace, fostering trust and a sense of safety.

Choice A is incorrect as it may overwhelm the patient by placing them in a social situation they are not ready for. Choice B is incorrect as discussing superficial topics does not address the patient's underlying issues. Choice C is incorrect as it may make the patient feel judged or pressured to speak, further isolating them.

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Which statement by the nurse indicates a good understanding of postpartum blues?

  • A. You need to get involved with taking care of this baby.
  • B. You are lucky to have a healthy baby. The patient in the next room would give anything to be in your place.
  • C. You look tired. Why dont you rest for a bit and I will come back later to start some teaching.
  • D. I will call the social worker to check into alternate caregiving for the new baby.
Correct Answer: C

Rationale: This response (C) indicates understanding that postpartum blues is transient and that time and rest are major healers. The other responses (A, B, D) are judgmental or inappropriate.

A patient with schizophrenia who admits to auditory hallucinations anxiously tells the nurse, 'The voice is telling me to do things.' Which of the following responses should the nurse make next?

  • A. Do you recognize the voice you hear?'
  • B. How long has this been happening?'
  • C. Does what the voice tells you to do frighten you?'
  • D. What is the voice telling you to do?'
Correct Answer: D

Rationale: The correct answer is D: "What is the voice telling you to do?" This response helps the nurse assess the content and potential danger of the hallucinations, guiding further interventions. Option A focuses on recognition, which is less urgent. Option B addresses duration, not immediate safety. Option C inquires about fear but does not directly address the hallucination's content. By asking what the voice commands, the nurse gains crucial insight for risk assessment and safety planning.

Which complication is most likely in a patient with bulimia nervosa who purges frequently?

  • A. Dehydration and electrolyte imbalances.
  • B. Increased appetite and weight gain.
  • C. Improved digestion and nutrient absorption.
  • D. High blood pressure and rapid heart rate.
Correct Answer: A

Rationale: The correct answer is A: Dehydration and electrolyte imbalances. Purging in bulimia nervosa involves self-induced vomiting or misuse of laxatives, leading to fluid and electrolyte loss. This can result in dehydration, electrolyte imbalances, and potentially life-threatening complications like cardiac arrhythmias. Increased appetite and weight gain (B) are less likely due to purging. Improved digestion and nutrient absorption (C) are not associated with frequent purging. High blood pressure and rapid heart rate (D) may occur in severe cases but are not the most likely complication.

Which theorist emphasized the role of social interaction in mental development?

  • A. Piaget
  • B. Vygotsky
  • C. Erikson
  • D. Freud
Correct Answer: B

Rationale: Vygotsky (B) emphasized social interaction and the Zone of Proximal Development in mental growth, unlike Piaget (A, cognitive stages), Erikson (C, psychosocial), or Freud (D, psychosexual).

After a person was abducted and raped at gunpoint by an unknown assailant, which assessment finding best indicates the acute phase of the rape-trauma syndrome?

  • A. Decreased motor activity
  • B. Confusion and disbelief
  • C. Flashbacks and dreams
  • D. Fears and phobias
Correct Answer: B

Rationale: The correct answer is B: Confusion and disbelief. During the acute phase of rape-trauma syndrome, the victim may experience feelings of confusion and disbelief as they try to process the traumatic event. This initial reaction is a common response to such a severe and violating experience. The victim may struggle to comprehend what has happened to them, leading to feelings of shock and disbelief. This phase is characterized by emotional numbing, disorientation, and difficulty in making decisions.

Decreased motor activity (Choice A) is not specific to the acute phase of rape-trauma syndrome and can be a general response to trauma. Flashbacks and dreams (Choice C) are more commonly associated with the intrusion phase of the syndrome, which occurs after the acute phase. Fears and phobias (Choice D) may develop later in the reorganization phase of the syndrome as the victim tries to cope with the aftermath of the trauma.

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