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Because a client is taking an MAO inhibitor, it is necessary to discuss the need for adherence to a low-tyramine diet. Which of the following are foods that she should avoid?
- A. Pickled, aged, smoked, and fermented foods
- B. Fresh vegetables
- C. Broiled fresh fish and fowl
- D. Fresh fruit such as apples and oranges
Correct Answer: A
Rationale: These foods may produce elevation in blood pressure when consumed during MAO inhibition therapy. These foods have not been pickled, fermented, smoked, or aged. They contain very little, if any, tyramine or tryptophan. As long as the meat has not been aged or smoked, it is within the dietary regimen. Fresh fruits can be consumed as desired. However, the consumption of bananas is limited.
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A 16-year-old client with anorexia nervosa is on an inpatient psychiatric unit. She has a fear of gaining weight and is refusing to eat sufficient amounts to maintain body weight for her age, height, and stature. To assist with the problem of powerlessness and plan for the client to no longer need to withhold food to feel in control, the nurse uses the following strategy:
- A. Establish a structured environment with routine tasks and activities. Also, serve meals at the same time each day.
- B. Distract the client during meals to get her to eat because she must take in sufficient amounts to keep from starving.
- C. Do frequent room checks to be sure that the client is not hiding food or throwing it away.
- D. Listen attentively and participate in in-depth discussions about food, because these actions may encourage her to eat.
Correct Answer: A
Rationale: Anorexia nervosa clients feel out of control. Providing a structured environment offers safety and comfort and can help them to develop internal control, thus reducing their need to control by self-starvation. Distraction does not focus on the client's need for control. Doing frequent room checks reinforces feelings of powerlessness and the need to continue with the dysfunctional behavior. Participating in long discussions about food does not make the client want to eat, but rather this strategy allows her to indulge in her preoccupation and to continue with the dysfunctional behavior.
A family by court order undergoes treatment by a family therapist for child abuse. The nurse, who is the child's case manager knows that treatment has been effective when:
- A. The child is removed from the home and placed in foster care
- B. The child's parents identify the ways in which he is different from the rest of the family
- C. The child's father is arrested for child abuse
- D. The child's parents can identify appropriate behaviors for children in his age group
Correct Answer: D
Rationale: Removing an abused child from the home and placement in a foster home are not the desired outcome of treatment. Children who are perceived as 'different' from the rest of the family are more likely to be abused. Although legal action may be taken against abusive parents, it is not an indicator of an effective treatment program. Identification of age-appropriate behaviors is essential to the role of parents, because misunderstanding children's normal developmental needs often contributes to abuse or neglect.
A home health nurse has several elderly clients in her case load. Which of the following clients ~(is most likely to be a victim of elder abuse?
- A. A 76-year-old female with Alzheimer's dementia
- B. A 70-year-old male with diabetes mellitus
- C. A 64-year-old female with a hip replacement
- D. A 72-year-old male with Parkinson's disease
Correct Answer: A
Rationale: Elderly clients with Alzheimer's dementia are at highest risk for abuse due to cognitive impairment, dependency, and potential caregiver stress. The other conditions pose less risk.
In assessing cardiovascular clients with progression of aortic stenosis, the nurse should be aware that there is typically:
- A. Decreased pulmonary blood flow and cyanosis
- B. Increased pressure in the pulmonary veins and pulmonary edema
- C. Systemic venous engorgement
- D. Increased left ventricular systolic pressures and hypertrophy
Correct Answer: D
Rationale: These signs are seen in pulmonic stenosis or in response to pulmonary congestion and edema and mitral stenosis. These signs are seen primarily in mitral stenosis or as a late sign in aortic stenosis after left ventricular failure. These signs are seen primarily in right-sided heart valve dysfunction. Left ventricular hypertrophy occurs to increase muscle mass and overcome the stenosis; left ventricular pressures increase as left ventricular volume increases owing to insufficient emptying.
A client suffering from schizophrenia has been taking chlorpromazine (Thorazine) for 6 months. On one of his follow-up visits to the mental health center, the nurse reports to the physician that he has developed tardive dyskinesia. Which of the following symptoms might she have observed in the client to support this conclusion?
- A. High fever, tachycardia, stupor, renal failure
- B. Lip smacking, chewing, blinking, lateral jaw movements
- C. Photosensitivity, orthostatic hypotension, dry mouth
- D. Constipation, blurred vision, drowsiness
Correct Answer: B
Rationale: These symptoms are found in clients with tardive dyskinesia.