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An 82-year-old widow with Alzheimer's disease lives with her daughter's family, which owns a catering business. During the week, the patient attends a daycare center for patients. During the evenings, members of the family care for the patient. One day, the nurse at the daycare center notices the patient's appearance is disheveled and that she has bruises on her wrists and back when escorted to the bathroom. What most likely explains the nurse's observations?

  • A. The patient is being neglected and abused within the family.
  • B. The dementia is progressing, reducing self-care and increasing falls.
  • C. The patient is experiencing normal aging symptoms.
  • D. The patient is suffering from a new medical condition.
Correct Answer: A

Rationale: The correct answer is A because the nurse's observations of disheveled appearance, bruises, and signs of physical abuse indicate possible neglect and abuse within the family. This is supported by the presence of Alzheimer's disease, vulnerability due to age, and the patient's living situation with family members who own a catering business. Choice B is incorrect as it does not explain the bruises and neglect observed. Choice C is incorrect as normal aging symptoms would not typically include bruises and neglect. Choice D is incorrect as there is no indication of a new medical condition causing these specific observations.

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A 25-year-old individual was brought by ambulance to the emergency room. The patient's sensorium alternates between clouded and clear, and the patient becomes agitated both physically and verbally when approached. The patient's roommate states that the patient "was fine after getting up this morning but started talking crazy about 3 hours ago." The patient's cognitive impairment is most consistent with:

  • A. delirium.
  • B. dementia.
  • C. sundown syndrome.
  • D. early-onset Alzheimer disease.
Correct Answer: A

Rationale: The correct answer is A: delirium. Delirium is an acute change in mental status characterized by fluctuating levels of consciousness, inattention, disorganized thinking, and altered perception. In this case, the patient's clouded and clear sensorium, agitation, and recent onset of symptoms are indicative of delirium.

Choice B: dementia, is incorrect because dementia is a chronic, progressive decline in cognitive function that does not typically present with acute changes in mental status.

Choice C: sundown syndrome, is incorrect as it refers to a pattern of worsening confusion or agitation in the late afternoon or evening, not necessarily characterized by acute onset and fluctuating levels of consciousness.

Choice D: early-onset Alzheimer disease, is incorrect because Alzheimer's disease is a specific type of dementia that does not typically present with the acute and fluctuating symptoms described in the scenario.

A women who is 16 weeks pregnant presents with symptoms suggestive of a urinary tract infection. Which one of the following is correct?

  • A. She should be assured that urinary tract infections are common in pregnancy and require no treatment.
  • B. A midstream urine should be collected and the bacteriology report awaited.
  • C. A midstream urine should be collected and a wide spectrum antibiotic prescribed.
  • D. A self-retaining catheter should be introduced to promote free drainage of urine.
Correct Answer: C

Rationale: In pregnancy, UTIs require prompt treatment due to risks like pyelonephritis. Collecting a midstream urine and starting a broad-spectrum antibiotic (C) is standard, pending culture results. Ignoring treatment (A), waiting without antibiotics (B), or invasive measures (D, E) are inappropriate.

When making a distinction as to whether an elderly patient has confusion related to delirium or another problem, what information would be of particular value?

  • A. Evidence of spasticity or flaccidity
  • B. The patients level of motor activity
  • C. Medications the patient has recently taken
  • D. Level of preoccupation with somatic symptoms
Correct Answer: C

Rationale: Delirium in the elderly produces symptoms of confusion. Medication interactions or adverse reactions are often a cause. The distracters do not give information important for delirium.

A newly admitted patient with schizophrenia approaches the unit nurse and says, 'The voices are bothering me. They are yelling and telling me stuff. They are really bad.' Which response by the nurse would be most appropriate?

  • A. Do you hear these voices very often?'
  • B. Do you have a plan for getting away from the voices?'
  • C. I'll stay with you. Tell me what you are hearing.'
  • D. Try to ignore them and play cards with the others.'
Correct Answer: C

Rationale: The correct answer is C because it demonstrates active listening and empathy, which can help establish trust and rapport with the patient. By saying, "I'll stay with you. Tell me what you are hearing," the nurse acknowledges the patient's distress and offers support. This response can help the patient feel heard and understood, which is crucial in managing symptoms of schizophrenia.

Choice A is incorrect as it focuses more on the frequency rather than addressing the immediate distress. Choice B is incorrect as it assumes the patient has a plan to escape the voices, which may not be the case and can escalate the situation. Choice D is incorrect as it dismisses the patient's experience and suggests distraction rather than addressing the underlying issue.

A core feature of all abnormal behavior is that it is

  • A. culturally absolute
  • B. learned
  • C. maladaptive
  • D. dependent on age
Correct Answer: C

Rationale: Maladaptive behavior, impairing function or causing distress, is a universal hallmark of abnormality.

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