Nokea
An adult seeks treatment for urges involving sexual contact with children. The adult has not acted on these urges but feels shame. Which finding best indicates that this adult is making progress in treatment? The adult
- A. consistently avoids schools and shops at malls only during school hours.
- B. indicates sexual drive and enjoyment from sex have decreased.
- C. reports an active and satisfying sex life with an adult partner.
- D. volunteers to become a scout troop leader.
Correct Answer: A
Rationale: The correct answer is A because the adult is demonstrating a proactive approach by avoiding situations where they may be tempted to act on their urges, showing an understanding of their triggers and a commitment to prevention. Choice B may indicate progress, but it does not directly address the urge towards children. Choice C, while positive, does not address the issue of pedophilic urges. Choice D is concerning as it places the individual in close proximity to potential victims.
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An elderly client who lives with her daughter and son-in-law and their three children reveals that her daughter sometimes slaps her when she does not move fast enough or spills things. The daughter is a mid-level business executive who is under considerable stress at work. The children are often left in the care of the elderly client. The husband is often out of town on business trips. The daughter states, 'I have so much to do that I become frustrated when my mother can't move fast enough or causes me extra work.' The nurse caring for the mother could appropriately suggest:
- A. Family therapy.
- B. Individual counseling for the daughter.
- C. Respite care for the elderly client.
- D. None of the above.
Correct Answer: A
Rationale: The correct answer is A: Family therapy. Family therapy is the most appropriate suggestion because it addresses the dysfunctional dynamics within the family and provides an opportunity for all family members to work through their issues. In this scenario, the daughter's stress at work and lack of coping skills are contributing to the abuse of the elderly client. Family therapy can help the family communicate effectively, set boundaries, and address underlying issues causing the abuse.
Choice B (Individual counseling for the daughter) may help the daughter address her stress and coping mechanisms, but it does not address the family dynamics that are contributing to the abuse. Choice C (Respite care for the elderly client) provides temporary relief but does not address the root cause of the issue. Choice D (None of the above) is incorrect as family therapy is the most appropriate intervention in this case.
During an initial patient interview, the psychiatric-mental health nurse begins by asking the patient to describe their:
- A. current situation
- B. feelings about the current situation
- C. personal history
- D. thoughts about the current situation
Correct Answer: A
Rationale: Starting with the current situation provides a concrete entry point to assess the patient's immediate needs and context.
A patient diagnosed with serious mental illness was living successfully in a group home but wanted an apartment. The prospective landlord said, 'People like you have trouble getting along and paying their rent.' The patient and nurse meet for a problem-solving session. Which options should the nurse endorse? Select one tha does not apply.
- A. Coach the patient in ways to control symptoms effectively
- B. Seek out landlords less affected by the stigma associated with mental illness
- C. Threaten the landlord with legal action because of the discriminatory actions
- D. Have the case manager meet with the landlord to provide education about mental illness
Correct Answer: C
Rationale: Managing symptoms so that they are less obvious or socially disruptive can reduce negative reactions and reduce rejection due to stigma. Seeking a more receptive landlord might be the most expeditious route to housing for this patient. Educating the landlord to reduce stigma might make him more receptive and give the case manager an opportunity to address some of his concerns (e.g., the case manager could arrange a payee to assure that the rent is paid each month). However, threatening a lawsuit would increase the landlords defensiveness and would likely be a long and expensive undertaking. Delaying the patients efforts to become more independent is not clinically necessary according to the data noted here; the problem is the landlords bias and response, not the patients illness. It would be unethical to encourage falsification and poor role modeling to do so; further, if falsification is discovered, it could permit the landlord to refuse or cancel her lease.
A nurse is caring for a patient with bulimia nervosa who is experiencing frequent purging. What is a priority assessment?
- A. Monitor electrolyte levels and cardiac function.
- B. Observe for signs of dehydration and low blood pressure.
- C. Assess for any compulsive exercise behaviors.
- D. Monitor for changes in eating patterns and food preferences.
Correct Answer: A
Rationale: The correct answer is A, to monitor electrolyte levels and cardiac function. This is a priority assessment because frequent purging in bulimia nervosa can lead to electrolyte imbalances and cardiac complications, such as arrhythmias and heart failure. Monitoring these parameters is crucial for early detection and intervention to prevent serious health consequences. Observing for signs of dehydration and low blood pressure (Choice B) is important but not as critical as monitoring electrolyte levels and cardiac function. Assessing for compulsive exercise behaviors (Choice C) and monitoring changes in eating patterns and food preferences (Choice D) are also relevant but secondary to the immediate risk of electrolyte imbalances and cardiac issues.
A 72-year-old female patient has the medical diagnosis of delirium secondary to anticholinergic medication toxicity. A nurse planning discharge care must consider the need to teach the family to be alert for maladaptive cognitive symptoms because:
- A. delirium is a hypersensitivity reaction.
- B. the elderly often deny changes in cognition.
- C. elderly females are more prone to delirium than elderly males.
- D. slower metabolism in the elderly predisposes to medication toxicity.
Correct Answer: D
Rationale: The correct answer is D because slower metabolism in the elderly can lead to medication toxicity, including anticholinergic toxicity causing delirium. As people age, their metabolism slows down, making them more susceptible to drug accumulation and toxicity. This can result in cognitive symptoms like delirium.
A: Delirium is not a hypersensitivity reaction; it is an acute state of confusion.
B: Denial of cognitive changes is not directly related to the risk of medication toxicity in the elderly.
C: Gender is not a significant factor in medication toxicity leading to delirium; it is more related to individual metabolism and drug interactions.