Nokea
A student nurse visiting a senior center says, 'Its depressing to see these old people. They are weak and frail. I doubt any of them can engage in a discussion.' The student is expressing:
- A. reality
- B. ageism
- C. empathy
- D. vulnerability
Correct Answer: B
Rationale: Ageism is a bias against older people because of their age. None of the other options applies to the ideas expressed by the student.
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The patient tells his primary nurse 'I get into trouble because I have hair-trigger responses. I shoot from the hip. Lots of times that gets me into a mess.' Which response would be most therapeutic?
- A. Let's look at ways to help you slow it down and think before acting.'
- B. It might help to explore how you came to be that way"“any ideas?'
- C. I'll bet you have some interesting stories to share about overreacting.'
- D. It's good that you're showing readiness and motivation to change.'
Correct Answer: A
Rationale: The correct answer is A because it demonstrates empathy and offers a therapeutic approach to help the patient manage their hair-trigger responses. By suggesting ways to slow down and think before acting, the nurse is providing practical strategies for the patient to work on self-regulation and impulse control. This response shows active listening and a commitment to supporting the patient in developing coping mechanisms.
Option B is incorrect as it focuses on exploring the root cause rather than offering immediate support. Option C is incorrect as it may encourage dwelling on past mistakes rather than focusing on problem-solving. Option D is incorrect as it praises the patient without addressing the need for behavior change.
What is the primary source of mental stimulation in early childhood?
- A. Television
- B. Parental interaction
- C. Toys
- D. School lessons
Correct Answer: B
Rationale: Parental interaction (B) provides responsive, tailored stimulation critical for early mental development. TV (A) and toys (C) are less interactive, and school lessons (D) come later.
Which of the following is an expected finding for a patient with anorexia nervosa?
- A. Increased appetite and food cravings.
- B. A body mass index (BMI) in the normal range.
- C. Bradycardia and hypotension.
- D. Elevated blood pressure and rapid pulse.
Correct Answer: C
Rationale: The correct answer is C. Patients with anorexia nervosa often have bradycardia and hypotension due to the physiological effects of severe malnutrition. Explanation: Severe restriction of food intake leads to decreased energy stores, causing the body to slow down its metabolic processes, including heart rate and blood pressure. Bradycardia and hypotension are common findings in individuals with anorexia nervosa.
Summary:
A: Increased appetite and food cravings are not expected findings in anorexia nervosa as patients typically have a decreased appetite.
B: A body mass index (BMI) in the normal range is not expected in anorexia nervosa, as patients often have a low BMI due to significant weight loss.
D: Elevated blood pressure and rapid pulse are not typical findings in anorexia nervosa; rather, patients may present with low blood pressure and bradycardia.
Older adults have reached Erikson's developmental stage of ego integrity when they:
- A. acknowledge that one cannot get everything one wants in life
- B. assess their lives and identify actions that had value and purpose
- C. express a wish that life could be relived differently
- D. feel that they are being punished for things they did not do
Correct Answer: B
Rationale: Ego integrity involves reflecting on life with acceptance and finding meaning, per Erikson's theory.
Which of the following interventions should the nurse plan to use to reduce client focus on delusional thinking?
- A. Confronting the delusion
- B. Focusing on feelings suggested by the delusion
- C. Refuting the delusion with logic
- D. Exploring reasons the client has the delusion
Correct Answer: B
Rationale: The correct answer is B: Focusing on feelings suggested by the delusion. By addressing the underlying emotions associated with the delusion, the nurse can help the client process and cope with their feelings, ultimately reducing the intensity of the delusional thinking. Confronting the delusion (A) may lead to resistance and escalation. Refuting the delusion with logic (C) can be ineffective as it may reinforce the client's belief. Exploring reasons for the delusion (D) may not directly address the client's focus on delusional thinking.