Nokea
Identify five barriers to access of mental health services in Kenya
- A. Stigma
- B. Lack of facilities
- C. Cost
- D. Poor awareness
Correct Answer: A
Rationale:
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A 45-year-old married woman who works full time in a factory has recently been absent for 3-day periods on several occasions. Each time, she returned to work wearing dark glasses. Facial and body bruises were apparent. Her supervisor became suspicious that she was a victim of battering and referred her to the occupational health nurse. Which initial inquiry would be most important for the nurse to make?
- A. Tell me what has happened to you.'
- B. Did your husband beat you?'
- C. Why do you let this happen?'
- D. What can you do to prevent this?'
Correct Answer: A
Rationale: The correct answer is A: "Tell me what has happened to you." This open-ended question allows the woman to share her experience without judgment or assumptions. It shows empathy and respect for her autonomy. It is crucial for the nurse to gather information directly from the patient to understand the situation fully and provide appropriate support.
Choice B is incorrect because it assumes the woman's husband is the perpetrator without giving her a chance to disclose the information herself. This can be intimidating and may not lead to a truthful response.
Choice C is incorrect because it implies blame on the victim for the abuse, which is not appropriate. It does not focus on providing support or understanding the situation.
Choice D is incorrect as it puts the responsibility on the victim to prevent the abuse, which is not a helpful approach. The focus should be on providing support and understanding the victim's situation.
A client is admitted to a day hospital following an episode in which he purchased a gun to use while standing guard over his property to prevent a neighbor from erecting a boundary fence. His wife describes him as distrustful of the motives of others and often interpreting others' motives as threats. She mentions that one time he accused her of having an affair with a neighbor with whom she chatted occasionally. The care plan will list the priority outcome as 'Client will:
- A. admit his action was excessive based on the circumstance.'
- B. write the neighbor a letter of apology.'
- C. demonstrate trust in the nurse.'
- D. identify positive role models.'
Correct Answer: C
Rationale: Step-by-step rationale for why choice C is correct:
1. Building trust is essential in therapeutic relationships.
2. The client's distrustful nature and misinterpretation of others' motives indicate a lack of trust.
3. By demonstrating trust in the nurse, the client can begin to address his issues with mistrust.
4. Trust in the nurse can lead to better communication and engagement in therapy.
5. Trust in the nurse is foundational for therapeutic progress and successful outcomes.
Summary of why other choices are incorrect:
- Choice A: Admitting his action was excessive is important but does not address the underlying issue of trust.
- Choice B: Writing a letter of apology to the neighbor does not directly address the client's trust issues.
- Choice D: Identifying positive role models may be helpful, but building trust with the nurse is more immediate and directly related to the client's current issues.
You are a nurse meeting for the first time with a stage 3 Alzheimer's patient who is newly referred to your home health agency. Which assessment data about the patient and caregiver(s) would be most important to acquire during your first visit to the family's home?
- A. Is the house design such that patient access to exits and stairways can be restricted?
- B. Does the family understand that the disease is likely to prove fatal within 3 to 5 years?
- C. What resources is the patient's family able to access in their particular community?
- D. None of the above.
Correct Answer: A
Rationale: Step-by-step rationale:
1. Ensuring patient safety is a top priority, especially for a stage 3 Alzheimer's patient.
2. Restricting access to exits and stairways can prevent wandering and potential accidents.
3. This assessment is crucial for creating a safe environment for the patient.
4. Understanding the house design is essential for implementing appropriate safety measures.
Summary of other choices:
B. Understanding the prognosis is important but not as immediately critical as ensuring patient safety.
C. Knowing community resources is valuable but not as urgent as addressing safety concerns.
D. This choice is incorrect as assessing the house design for safety is crucial in this scenario.
When are the recommended ages for developmental screening to be done according to AAP guidelines?
- A. 6 months, 12 months, and 18 months
- B. 6 months, 18 months, and 36 months
- C. 18 months, 24 months, and 36 months
- D. 9 months, 18 months, and 30 months
Correct Answer: D
Rationale: The American Academy of Pediatrics (AAP) recommends developmental screening at 9, 18, and 30 months during well-child visits to identify developmental delays early.
A patient with many positive symptoms of schizophrenia, whose behavior is disorganized and who is highly anxious, tells the nurse in the psychiatric emergency department, 'You have got to help me. I do not know what is going on. I think someone is trying to wipe me out. I have to get a gun.' The patient, a college student, lives alone and has no family or support system in the immediate area. He has not left his room in 2 weeks, has not eaten in several days, and is unkempt. Of the available treatment settings, the nurse should recommend:
- A. admission to an unlocked residential crisis unit.
- B. inpatient hospitalization on a locked unit.
- C. attending a day treatment program for 4 weeks.
- D. admission to a partial hospital program.
Correct Answer: B
Rationale: The correct answer is B: inpatient hospitalization on a locked unit. This option is the most appropriate given the patient's presentation. The patient is experiencing severe positive symptoms of schizophrenia, such as delusions and disorganized behavior, posing a risk to himself and others by expressing intent to obtain a gun. Additionally, the patient is neglecting basic needs, indicating a need for close monitoring and intervention. Inpatient hospitalization on a locked unit provides a structured and secure environment for intensive treatment, ensuring safety and stabilization.
Incorrect choices:
A: Admission to an unlocked residential crisis unit may not provide the level of monitoring and security needed for a patient with active psychotic symptoms and self-harm potential.
C: Attending a day treatment program for 4 weeks does not address the acute safety concerns and level of impairment displayed by the patient.
D: Admission to a partial hospital program may not offer the round-the-clock supervision and immediate intervention required for someone at risk of harming themselves or others.