Nokea
A short-term goal for a patient with Alzheimer disease is:
- A. Improved functioning in the least restrictive environment
- B. improved problem solving in activities of daily living
- C. increased self-esteem and improved self-concept
- D. regained sensory perception and cognitive function
Correct Answer: A
Rationale: Promoting function in a safe, least restrictive setting is realistic and achievable given Alzheimer's progressive nature.
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A patient living independently had command hallucinations to shout warnings to neighbors. After a short hospitalization, the patient was prohibited from returning to the apartment. The landlord said, 'You cause too much trouble.' What problem is the patient experiencing?
- A. Grief
- B. Stigma
- C. Homelessness
- D. Nonadherence
Correct Answer: B
Rationale: The inability to obtain shelter because of negative attitudes about mental illness is an example of stigma. Stigma is defined as damage to reputation, shame, and ridicule society places on mental illness. Data are not present to identify grief as a patient problem. Data do not suggest that the patient is actually homeless.
True paranoids are rarely treated or admitted to hospitals because
- A. they are potentially harmful and dangerous to others
- B. they resist the attempts of others to offer help
- C. their severe hallucinations make reasoning with them impossible
- D. psychiatric hospitals are primarily for psychotics
Correct Answer: B
Rationale: Paranoid individuals' mistrust leads them to resist help, reducing treatment rates.
The expected outcome for a patient with a nursing diagnosis of disturbed thought processes is:
- A. The patient will be safe from injury.
- B. The patient will meet basic biological needs.
- C. The patient will achieve optimum cognitive functioning.
- D. The patient will maintain positive interpersonal relationships.
Correct Answer: C
Rationale: The correct answer is C because disturbed thought processes indicate cognitive impairment. Thus, the expected outcome should focus on improving cognitive functioning to achieve optimal mental clarity and decision-making. Safety (A) is important but not directly related to cognitive improvement. Meeting basic needs (B) and maintaining relationships (D) are important but not the primary focus when the diagnosis is disturbed thought processes. So, the priority is on enhancing cognitive functioning to address the root cause of the issue.
An 85-year-old client with dementia has a nursing diagnosis of Self-care deficit: bathing, hygiene. She lives at home and has not bathed for a month. Her 67-year-old daughter states that she thinks her mother may have forgotten how to take a shower. An appropriate outcome would be that the client will:
- A. Bathe daily with reminders
- B. Bathe twice weekly with assistance
- C. Allow the nurse to totally manage hygiene
- D. Remain free of skin diseases/lesions
Correct Answer: B
Rationale: The correct answer is B: Bathe twice weekly with assistance. This outcome is appropriate because it takes into account the client's dementia and self-care deficit while also promoting hygiene and independence. Daily bathing may be overwhelming for the client and may not be necessary for maintaining good hygiene. Allowing the nurse to totally manage hygiene (choice C) may not promote the client's independence. Remaining free of skin diseases/lesions (choice D) is important but may not directly address the self-care deficit. Bathe twice weekly with assistance strikes a balance between promoting hygiene and respecting the client's abilities and limitations.
A novice nurse tells the assigned mentor, 'I admitted a patient today who has several bizarre delusions. I wanted to tell the patient that the ideas and conclusions simply are not logical. What do you think will happen if I do?' Which reply by the mentor is best?
- A. I think you'll give the patient something to think about.'
- B. The patient will probably incorporate you into the delusions as a persecutor.'
- C. Develop trust using empathy and calmness before pointing out discrepancies.'
- D. Initially, it would be better to go along with the patient's thinking to gain cooperation.'
Correct Answer: C
Rationale: Step 1: Establish trust - Developing trust with the patient is crucial in building a therapeutic relationship.
Step 2: Use empathy and calmness - Showing empathy helps the patient feel understood and valued.
Step 3: Point out discrepancies - Once trust is established, gently pointing out discrepancies in a non-confrontational manner can help the patient reflect on their delusions.
Summary: Choice C is the best because it emphasizes the importance of building trust and rapport before addressing the patient's delusions. Choices A, B, and D are incorrect because they do not prioritize the therapeutic relationship or show empathy towards the patient's experiences.