Population Based Care

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A woman became severely depressed when the last of her six children moved out of the home 4 months ago. Since then she has neglected to care for herself, sleeps poorly, lost weight, and repeatedly states, "No one cares about me anymore. I'm worthless." After hospitalization, the nursing diagnosis of situational low self-esteem related to feelings of abandonment was identified. The nurse wishes to reinforce the patient's self-esteem by acknowledging the improvement in her personal appearance. She's wearing a new dress and has combed her hair. The most appropriate remark would be:

  • A. You look very nice this morning, Mrs. J.
  • B. I like the dress you're wearing, it's very pretty.
  • C. What brought about this glamorous transformation?
  • D. You've combed your hair and are wearing a new dress.
Correct Answer: A

Rationale: The correct answer is A because it directly compliments Mrs. J's personal appearance, reinforcing her self-esteem. By stating "You look very nice this morning, Mrs. J," the nurse acknowledges and validates Mrs. J's efforts to improve her appearance, which can help boost her self-esteem.

Choice B focuses solely on the dress, not directly addressing Mrs. J's overall appearance. Choice C may come across as insincere or too focused on the transformation rather than Mrs. J herself. Choice D, while acknowledging the hair and dress, lacks the personal and direct compliment needed to reinforce self-esteem effectively.

In summary, choice A is the best option as it provides a genuine and direct compliment that can positively impact Mrs. J's self-esteem.

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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.

Priority nursing interventions for a client with borderline personality disorder who has a history of self-mutilation and is currently angry, irritable, and impulsive would be:

  • A. Establishing a contract for safety with the client
  • B. Teaching the client ways to manage anger
  • C. Helping the client tolerate feelings
  • D. Implementing behavioral modification
Correct Answer: A

Rationale: The correct answer is A: Establishing a contract for safety with the client. This is the priority intervention as it focuses on ensuring the client's immediate safety. By setting up a contract for safety, the nurse can collaborate with the client on identifying warning signs and developing a plan to prevent self-harm.

Choice B (Teaching the client ways to manage anger) and Choice C (Helping the client tolerate feelings) are important interventions but may not be as urgent as ensuring the client's safety in this scenario.

Choice D (Implementing behavioral modification) is not the priority because the client's safety needs to be addressed first before focusing on behavioral changes.

The nurse is leading a group for women who have experienced interpersonal violence. A client asks what research statistics tell about the perpetrators of interpersonal violence. The nurse can accurately respond that perpetrators are:

  • A. Usually under the influence of drugs or alcohol
  • B. Most often someone the victim knows
  • C. A stranger to the victim in most cases
  • D. Often in a psychotic state during the act
Correct Answer: B

Rationale: The correct answer is B because research shows that perpetrators of interpersonal violence are most often someone the victim knows, such as a partner, family member, or acquaintance. This is supported by studies and data that indicate a significant majority of interpersonal violence cases involve perpetrators who have a prior relationship with the victim. Choice A is incorrect because while substance abuse can be a factor in some cases, it is not the primary characteristic of perpetrators. Choice C is incorrect as statistics show that perpetrators are usually known to the victim rather than being strangers. Choice D is also incorrect as psychotic states are not typically the primary cause of interpersonal violence, and most perpetrators are not in such a state during the act.

In DSM-IV-TR intellectual disabilities are divided into a number of degrees of severity, depending primarily on the range of IQ score provided by the sufferer. One of these is Mild Mental Retardation, corresponding to an IQ score between:

  • A. 60-65 to 80
  • B. 40-55 to 60
  • C. 50-55 to 70
  • D. 70-75 to 90
Correct Answer: C

Rationale: Mild Mental Retardation: Defined by DSM-IV-TR as an IQ score between 50-55 to 70.

Several clients are members of a therapy group for clients with eating disorders. Of what particular use is this type of group therapy for treatment of eating disorders?

  • A. Spending time in a group setting helps the client focus on things other than food.
  • B. Interacting with clients who have similar problems helps prevent secondary gains related to being different.
  • C. Focusing on problems experienced by other group members helps the client avoid having to deal with personal concerns.
  • D. None of the above.
Correct Answer: B

Rationale: The correct answer is B because interacting with clients who have similar problems in a therapy group for eating disorders helps prevent secondary gains related to feeling different or unique in their struggles. This interaction can offer a sense of validation, support, and understanding, which can be crucial for individuals with eating disorders. It fosters a sense of belonging and reduces the feelings of isolation that often accompany these disorders.

Choice A is incorrect because the primary focus of group therapy for eating disorders is to address and work through issues related to food and body image, rather than distracting clients from these concerns.

Choice C is incorrect because the purpose of group therapy is to provide a safe space for clients to explore and address their personal concerns within a supportive group setting, not to avoid dealing with them.

Choice D is also incorrect as interacting with similar others in a therapy group has specific benefits for individuals with eating disorders.

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