Age Specific Considerations in Patient Care

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An older adult patient who lives with a daughter and attends the Alzheimer day hospital program exhibits bilateral bruising for the second time on both upper outer arms. When the nurse questions the patient about the bruising, the patient starts to cry and pleads, 'Please don't say anything. It's not my daughter's fault. I just bruise easily.' Which intervention reflects the best management of this situation?

  • A. Call the daughter to discuss both the bruising and her parent's reaction.
  • B. Report the elder abuse, and inform the patient and the daughter of your intention.
  • C. Notify the patient's social worker of the bruising after a complete assessment has been completed.
  • D. Inform the patient and the daughter of your intention to document the bruising and arrange for appropriate counseling.
Correct Answer: B

Rationale: The correct answer is B: Report the elder abuse and inform the patient and the daughter of your intention. This is the best intervention as it prioritizes the safety and well-being of the older adult. Here's the rationale:
1. The patient's repeated bruising and fear of disclosure indicate potential abuse.
2. Reporting elder abuse is mandatory to ensure protection for the patient.
3. Informing the patient and daughter shows transparency and involves them in the process.
4. It is crucial to address the situation promptly to prevent further harm.
Summary:
A: Calling the daughter may escalate the situation and compromise the patient's safety.
C: Notifying the social worker without addressing the abuse directly may delay necessary action.
D: Counseling may be beneficial, but addressing the abuse is a priority to ensure the patient's safety.

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After a person was abducted and raped at gunpoint by an unknown assailant, which assessment finding best indicates the acute phase of the rape-trauma syndrome?

  • A. Decreased motor activity
  • B. Confusion and disbelief
  • C. Flashbacks and dreams
  • D. Fears and phobias
Correct Answer: B

Rationale: The correct answer is B: Confusion and disbelief. During the acute phase of rape-trauma syndrome, the victim may experience feelings of confusion and disbelief as they try to process the traumatic event. This initial reaction is a common response to such a severe and violating experience. The victim may struggle to comprehend what has happened to them, leading to feelings of shock and disbelief. This phase is characterized by emotional numbing, disorientation, and difficulty in making decisions.

Decreased motor activity (Choice A) is not specific to the acute phase of rape-trauma syndrome and can be a general response to trauma. Flashbacks and dreams (Choice C) are more commonly associated with the intrusion phase of the syndrome, which occurs after the acute phase. Fears and phobias (Choice D) may develop later in the reorganization phase of the syndrome as the victim tries to cope with the aftermath of the trauma.

A group of teenagers are discussing their individual problems associated with having an eating disorder. Which findings would the nurse attribute to purging?

  • A. Excessive facial hair
  • B. Elevated blood pressure
  • C. Polyuria
  • D. Dental enamel erosion
Correct Answer: C

Rationale: Rationale for Correct Answer (C - Polyuria):
1. Purging involves self-induced vomiting or misuse of laxatives/diuretics.
2. Vomiting can lead to electrolyte imbalances, causing increased urine production (polyuria).
3. Polyuria is a common sign of purging behaviors due to electrolyte disturbances.

Summary of Incorrect Choices:
A: Excessive facial hair - Not directly related to purging behavior.
B: Elevated blood pressure - Could be related to stress or other factors, not specific to purging.
D: Dental enamel erosion - More likely associated with frequent vomiting (purging) rather than polyuria.

A child, aged 11 years, has to stay home from school to care for his siblings while his mother works, because the family cannot afford a babysitter. The father appears to be emotionally abusive. Which intervention could be used for the primary prevention of problems such as these?

  • A. Involve the parents in a parenting support group, and help them find affordable childcare.
  • B. Meet with elected officials to lobby for subsidized childcare and increasing the minimum wage.
  • C. Screen for signs of abuse and neglect in all children so that it can be discovered and treated early.
  • D. Provide supportive counseling services for those who have survived neglect or abuse.
Correct Answer: B

Rationale: The correct answer is B because lobbying for subsidized childcare and increasing the minimum wage addresses the root causes of the family's situation, such as financial insecurity and lack of affordable childcare. This intervention aims to prevent similar situations from occurring by advocating for systemic changes that can support families in need.

Choice A focuses on providing support to the parents, which may not address the underlying issues of financial instability and emotional abuse. Choice C addresses detection and treatment after the abuse has occurred, rather than preventing it from happening in the first place. Choice D focuses on providing counseling services after abuse or neglect has already taken place, rather than preventing it through systemic changes like subsidized childcare and increased minimum wage.

Which of the following is a common physical sign in patients with bulimia nervosa?

  • A. Hypotension and bradycardia.
  • B. Dental erosion and swollen parotid glands.
  • C. Rapid weight gain and increased appetite.
  • D. Severe muscle wasting and low body temperature.
Correct Answer: B

Rationale: The correct answer is B: Dental erosion and swollen parotid glands are common physical signs in patients with bulimia nervosa. Dental erosion is caused by repeated exposure of teeth to stomach acid during purging. Swollen parotid glands result from repeated vomiting. Hypotension and bradycardia (A) are more common in anorexia nervosa. Rapid weight gain and increased appetite (C) are not typical in bulimia nervosa; rather, patients often maintain a normal weight. Severe muscle wasting and low body temperature (D) are not commonly associated with bulimia nervosa.

A client has been admitted with disorganized type schizophrenia. The nurse observes blunted affect and social isolation. The client occasionally curses or calls another client a 'jerk' without provocation. The nurse asks the client how he is feeling, and he responds, 'Everybody picks on me. They frobitz me.' The best response for the nurse to make would be:

  • A. That's really too bad.'
  • B. Who do you mean when you say 'everybody'?'
  • C. What difference does frobitzing make?'
  • D. Why do they frobitz?'
Correct Answer: B

Rationale: The correct answer is B: "Who do you mean when you say 'everybody'?"

Rationale:
1. Clarifying the client's statement helps to understand his perception.
2. Asking specifically about 'everybody' encourages the client to express his feelings and thoughts.
3. It promotes therapeutic communication by showing empathy and active listening.

Incorrect choices:
A: "That's really too bad." - This response does not address the client's specific concerns or promote further exploration.
C: "What difference does frobitzing make?" - This response is dismissive and lacks empathy or understanding of the client's experience.
D: "Why do they frobitz?" - This response is confrontational and may come across as accusatory, potentially shutting down communication.

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