Population Specific Care

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A widow, aged 72 years, lives alone and is visited weekly by her son. She takes digoxin, hydrochlorothiazide, and an antihypertensive drug. She also has a prescription for diazepam (Valium) as needed for moderate to severe anxiety. When the son visited today, he found his mother confused and disoriented, with an unsteady gait. The nurse assessed the patient as having several cognitive problems, including memory and attention deficits and fluctuating levels of orientation. The nurse confirms that the patient's symptoms developed:

  • A. Over the past few days.
  • B. Over the past few weeks.
  • C. Over the past few months.
  • D. None of the above.
Correct Answer: A

Rationale: The correct answer is A: Over the past few days. The sudden onset of confusion, disorientation, and cognitive deficits in the elderly patient suggests an acute change in her condition. This acute change is more indicative of a recent event or medication-related issue rather than a gradual decline over weeks or months. The sudden onset could be due to factors such as medication interactions, overdose, or underlying medical conditions. It is crucial to investigate recent changes in medications, lab results, or any other potential triggers that might have led to this acute cognitive decline. Choices B, C, and D are incorrect because they imply a gradual decline over weeks, months, or no specific timeframe, which does not align with the sudden onset observed in the patient.

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In Singapore, MSF-funded disability services for preschool children:

  • A. Serve those with congenital, physical, sensory, developmental, and behavioural disorders
  • B. Are all centre-based
  • C. Provided by charity and public hospitals only
  • D. Are overseen by the Early Childhood Developmental Agency (EDCA)
Correct Answer: A

Rationale: MSF-funded services cover a broad range of disabilities in preschoolers, aligning with Singapore's inclusive disability framework.

A 32-year-old client with an admitting diagnosis of catatonic schizophrenia has been mute and motionless for 2 days. The priority nursing diagnosis is:

  • A. Risk for deficient fluid volume
  • B. Impaired physical mobility
  • C. Impaired social interaction
  • D. Ineffective coping
Correct Answer: A

Rationale: The correct answer is A: Risk for deficient fluid volume. The priority nursing diagnosis in this case is to address the client's physical needs to ensure their safety and well-being. The client's mutism and immobility put them at risk for dehydration and malnutrition. By prioritizing the risk for deficient fluid volume, the nurse can address the immediate physiological needs of the client.

Choice B: Impaired physical mobility is incorrect because while the client is motionless, the immediate concern is addressing the risk of dehydration.

Choice C: Impaired social interaction is incorrect as addressing social interaction is not the priority when the client's physical needs are not being met.

Choice D: Ineffective coping is incorrect because the client's presentation is indicative of a more urgent physical need for hydration and nutrition.

Which of the following is the main neurological birth syndrome caused by anoxia?

  • A. Down Syndrome
  • B. Fragile X syndrome
  • C. Cerebral palsy
  • D. Cerebral Vascular accident
Correct Answer: C

Rationale: Cerebral Palsy: The main neurological birth syndrome caused by anoxia, characterized by motor symptoms affecting strength and coordination.

A 14-year-old client on the eating disorders unit refuses to eat her meals and says to the nurse on the unit, 'You can't make me eat! There is nothing wrong with me.' The nurse will assess this as use of which defense mechanism?

  • A. Repression.
  • B. Rationalization.
  • C. Sublimation.
  • D. Denial.
Correct Answer: D

Rationale: The correct answer is D: Denial. Denial is a defense mechanism where an individual refuses to acknowledge reality to avoid discomfort. In this scenario, the client is denying the seriousness of their situation by refusing to eat and claiming there is nothing wrong. Repression (A) involves unconsciously blocking out unpleasant thoughts or feelings. Rationalization (B) is creating logical explanations to justify behavior. Sublimation (C) is redirecting negative impulses into positive behaviors. In this case, denial is the most fitting defense mechanism as the client is refusing to accept the reality of their eating disorder.

The spouse of a man being treated with sertraline (Zoloft) calls to report that he had a grand mal seizure. Prior to the seizure, he had seemed confused and his forehead felt hot. The man does not have a seizure-disorder history. Which action should the nurse direct the spouse to take?

  • A. Monitor the patient and notify the clinic if there are more seizures.
  • B. Hold all medications and call 911 for transportation to the hospital.
  • C. Hold tonight's sertraline and encourage him to drink more fluids.
  • D. Administer an antipyretic drug to lower his fever and prevent seizures.
Correct Answer: B

Rationale: Step 1: The man had a grand mal seizure, confusion, and a hot forehead, which are signs of serotonin syndrome, a serious side effect of sertraline.
Step 2: The nurse should direct the spouse to hold all medications to prevent further serotonin syndrome symptoms.
Step 3: Calling 911 for immediate transportation to the hospital is crucial for prompt evaluation and treatment of the seizure and serotonin syndrome.
Step 4: This action ensures the man receives appropriate medical care to address the seizure and manage the potential serotonin syndrome.
Summary:
- Choice A is incorrect as monitoring the patient at home is not sufficient for a serious medical emergency like serotonin syndrome.
- Choice C is incorrect as simply holding tonight's sertraline and encouraging fluids does not address the immediate need for medical intervention.
- Choice D is incorrect as administering an antipyretic drug does not address the underlying cause of the seizure and confusion, which is serotonin syndrome.

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