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For a client with obsessive-compulsive disorder, which reaction is most likely to occur when the performance of a ritual is interrupted?
- A. Anxiety
- B. Hostility
- C. Aggression
- D. Withdrawal
Correct Answer: A
Rationale: When a client with obsessive-compulsive disorder is interrupted while performing a ritual, the most likely reaction is anxiety. The compulsive ritual serves as a coping mechanism to control anxiety, so any disruption to this ritual can heighten the individual's anxiety levels. Hostility is typically part of the disorder itself and not a direct reaction to the interruption of the ritual. Aggression may occur only if anxiety escalates to a panic level, leading to overt anger expression. Withdrawal is not a common behavioral pattern associated with obsessive-compulsive disorder and is not a typical reaction to ritual interruption.
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Which dysfunction of the reproductive system is associated with anorexia nervosa in females?
- A. Galactorrhea
- B. Gynecomastia
- C. Amenorrhea
- D. Premenstrual dysphoric disorder
Correct Answer: C
Rationale: Amenorrhea (cessation of menses) is associated with anorexia nervosa in females due to endocrine imbalances resulting from depleted fat stores. Galactorrhea is a milky discharge from the nipples unrelated to normal breast milk production. Gynecomastia is swelling of breast tissue in males. Premenstrual dysphoric disorder occurs about 1 week before menses and includes mood swings, depression, fatigue, bloating, overeating, and difficulty focusing, resolving when menstruation starts. In the context of anorexia nervosa, the primary concern is the disruption of the menstrual cycle due to low body weight, leading to amenorrhea.
The spouse of a dying client states to the nurse, 'I don't think I can come anymore and watch her die. It's chewing me up too much!' Which is the most therapeutic response the nurse should make to the spouse?
- A. It's hard to watch someone you love die. You've been here with your wife every day. Are you taking any time for yourself?
- B. Focus on your wife's pain rather than yours. I know it's hard, but this isn't about what's happening to you, you know.
- C. I know it's hard for you, but she would know if you're not there, and you would feel so very guilty all of the rest of your days.
- D. I think you're making the right decision. Your wife knows you love her. You don't have to come every day. I'll take care of her.
Correct Answer: A
Rationale: The most therapeutic response is the one that is empathetic and that reflects the nurse's understanding of the client's, in this case, the husband's, stress and emotional pain. In the correct option, the nurse suggests that the client take time for himself. Option 2 is an example of a nontherapeutic and judgmental attitude that places blame. Option 3 makes statements that the nurse cannot know are true (the client's wife may not in fact know if the husband visits), and it predicts feelings of guilt, which is inappropriate. Option 4 fosters dependency and gives advice, which is nontherapeutic.
A mother complains to the nurse that her 3-year-old child refuses to go to preschool. The child rarely interacts and avoids playing with other children. Which statement would the nurse provide?
- A. Do not be concerned because all toddlers behave this way.
- B. Ask the teacher to push the child to speak up and open up to the other kids.
- C. Set boundaries and supervise the child closely.
- D. Give your child time to get acquainted and warm up to the new environment.
Correct Answer: D
Rationale: According to the mother's description, the child is a slow-to-warm-up child. These children are uneasy in new situations or with unfamiliar people. The nurse would educate the mother to give the child time to be more familiar with the new environment. All toddlers do not behave in the same manner. A slow-to-warm-up child should not be pressured to do anything against his or her wishes. Setting boundaries and closely supervising the child is not the best approach for a child who needs time to adapt. Asking the teacher to push the child to open up can create more anxiety and stress for the child, which is not recommended.
A client diagnosed with Raynaud's disease tells the nurse that he has a stressful job and does not handle stressful situations well. Which life change should the nurse teach the client to consider to help alleviate his stress?
- A. Change to a less stressful job.
- B. Seek help from a psychologist.
- C. Consider a stress management program.
- D. Use earplugs to minimize environmental noise.
Correct Answer: C
Rationale: Stress can trigger the vasospasm that occurs with Raynaud's disease, so referral to a stress management program or the use of biofeedback training may be helpful. Option 1 is unrealistic. Option 2 is not necessarily required at this time. Option 4 does not specifically address the subject.
Why might a nurse manager suggest avoiding therapeutic group work for a client with schizophrenia who has paranoid delusions?
- A. Individuals with this disorder respond well to small therapeutic groups.
- B. Therapeutic group work tends to be threatening to individuals who are suspicious.
- C. Compliance with unit rules and medication regimens increases as therapeutic group involvement increases.
- D. Involvement in small therapeutic groups may decrease the regression and dependency associated with institutionalization.
Correct Answer: B
Rationale: The nurse manager would suggest avoiding therapeutic group work for a client with schizophrenia who has paranoid delusions because individuals who are suspicious find group settings threatening. Paranoid individuals struggle in groups as they may not trust others enough to engage effectively and tolerate the necessary interactions for group therapy. Therefore, the correct answer is that therapeutic group work tends to be threatening to individuals who are suspicious. Choices A, C, and D are incorrect. While some individuals with schizophrenia may respond well to small therapeutic groups, those with paranoid delusions may find them threatening. Compliance with unit rules and medication regimens may not necessarily increase with group therapy, especially for acutely ill psychiatric clients not ready to accept reality. Involvement in small therapeutic groups is not primarily aimed at decreasing regression and dependency associated with institutionalization, making it an inappropriate option for the client's specific needs.