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During a mental status examination, which of the following components should be included in the assessment? Select one that doesn't apply.
- A. Appearance and behavior
- B. Thought processes
- C. Mood and affect
- D. The greater the cultural distance from the mainstream of society, the greater the likelihood that the illness will be treated with sensitivity and compassion.
Correct Answer: D
Rationale: During a mental status examination, key components to be assessed include the client's appearance and behavior, thought processes, mood and affect, and cognitive function. These components help in evaluating the client's mental health status. The statement about cultural distance and illness treatment is not a part of a mental status examination and is not relevant to the assessment of mental health. Choices A, B, and C are essential components of a mental status examination and contribute to a comprehensive evaluation of an individual's mental well-being.
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During an intake assessment, a healthcare professional asks both physiological and psychosocial questions. The client angrily responds, 'I'm here for my heart, not my head problems.' What is the healthcare professional's best response?
- A. It's just a routine part of our assessment. All clients are asked these same questions.
- B. Why are you concerned about these types of questions?
- C. Psychological factors, like excessive stress, have been found to affect medical conditions.
- D. We can skip these questions, if you like. It isn't imperative that we complete this section.
Correct Answer: C
Rationale: The healthcare professional should educate the client on the negative effects of excessive stress on medical conditions. Understanding the interconnectedness of physical and mental health is crucial for providing holistic care. Choice A is incorrect because it doesn't address the importance of psychosocial aspects. Choice B is wrong as it doesn't provide relevant information about the impact of psychological factors on health. Choice D is incorrect because skipping questions would lead to an incomplete assessment, potentially missing crucial information affecting the client's overall health outcomes.
A healthcare professional is assessing a client with obsessive-compulsive disorder (OCD). Which of the following findings should the professional expect? Select one that does not apply.
- A. Recurrent, intrusive thoughts
- B. Compulsive behaviors
- C. Delusions of grandeur
- D. Avoidance of situations that trigger obsessions
Correct Answer: C
Rationale: Obsessive-compulsive disorder (OCD) is characterized by recurrent, intrusive thoughts (obsessions), compulsive behaviors, and avoidance of situations that trigger obsessions. Delusions of grandeur, which involve inflated beliefs about one's own importance or abilities, are not typically associated with OCD. Therefore, the presence of delusions of grandeur would not be an expected finding in a client with OCD. Choices A, B, and D are all typical features of OCD and would be expected findings during the assessment of a client with this disorder.
A nursing instructor is discussing diseases of adaptation with students and when they are likely to occur. Which student response indicates that learning has occurred?
- A. When an individual has limited experience managing stress
- B. When an individual inherits adaptive genes
- C. When an individual faces pre-existing conditions that worsen stress
- D. When an individual's physiological and psychological resources are depleted
Correct Answer: D
Rationale: The correct answer is D. During the stage of exhaustion in the general adaptation syndrome, an individual's physiological and psychological resources become depleted, leading to a reduced capacity to adapt effectively. This depletion of resources is when diseases of adaptation, such as stress-related disorders, are more likely to occur. Choices A, B, and C do not reflect an accurate understanding of diseases of adaptation. Limited experience managing stress, inheriting adaptive genes, and facing pre-existing conditions that worsen stress do not directly relate to the concept of physiological and psychological resource depletion leading to diseases of adaptation.
When an individual's stress response is sustained over a long period of time, which physiological effect of the endocrine system should one anticipate?
- A. Decreased resistance to disease
- B. Increased libido
- C. Decreased blood pressure
- D. Increased inflammatory response
Correct Answer: A
Rationale: When stress is prolonged, the body reaches the stage of exhaustion in the general adaptation syndrome, where compensatory mechanisms fail, and diseases of adaptation may occur. One physiological effect includes a decreased immune response, leading to decreased resistance to disease. Therefore, the correct answer is A. Increased libido (choice B) is not a typical physiological effect related to prolonged stress. Decreased blood pressure (choice C) is not commonly associated with sustained stress. Increased inflammatory response (choice D) may occur in the short term due to stress, but over a prolonged period, the immune system's function weakens, leading to decreased resistance to disease.
A healthcare professional is caring for a patient with bipolar disorder who is experiencing a manic episode. Which intervention is most appropriate?
- A. Encourage group activities to increase socialization.
- B. Provide a structured environment with limited stimuli.
- C. Allow the patient to engage in physical activities freely.
- D. Give the patient detailed and complex tasks to complete.
Correct Answer: B
Rationale: During a manic episode, individuals with bipolar disorder may have heightened sensitivity to stimuli and may struggle with organization and decision-making. Providing a structured environment with limited stimuli can help reduce triggers and maintain a sense of control for the patient. It is essential to create a calm and predictable setting to support the individual in managing their symptoms effectively. Choice A is incorrect as group activities may overwhelm the patient due to increased stimuli. Choice C is not the most appropriate because unstructured physical activities may exacerbate the manic symptoms. Choice D is not recommended as detailed and complex tasks can be overwhelming and may contribute to increased stress and agitation in a manic episode.