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In DSM-IV-TR intellectual disabilities are divided into a number of degrees of severity, depending primarily on the range of IQ score provided by the sufferer. One of these is Severe Mental Retardation, represented by an IQ score between:
- A. 5-10 to 15-20
- B. 30-35 to 45-50
- C. 10-15 to 20-25
- D. 20-25 to 35-40
Correct Answer: D
Rationale: Severe Mental Retardation: Defined by DSM-IV-TR as an IQ score between 20-25 to 35-40.
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A 15-year-old boy presents with fatigue to the clinic. He reports that he is unable to wake up in the mornings and is missing a lot of school. On further questioning he reveals that he has some thoughts of suicide, but requests that the information be withheld from his parent who is in the waiting room. On examination he is noted to be obese with acanthosis. The next best step is to ensure his safety is:
- A. Refer to peds medicine for workup of obesity
- B. Breach confidentiality to inform his parent about the adolescents suicidal thoughts
- C. Refer to school for counselling
- D. Reassurance and diet and exercise advice
Correct Answer: B
Rationale: Suicidal thoughts indicate a safety risk, justifying breaching confidentiality to involve parents and ensure immediate intervention, per ethical and clinical guidelines.
A newly admitted patient with schizophrenia approaches the unit nurse and says, 'The voices are bothering me. They are yelling and telling me stuff. They are really bad.' Which response by the nurse would be most appropriate?
- A. Do you hear these voices very often?'
- B. Do you have a plan for getting away from the voices?'
- C. I'll stay with you. Tell me what you are hearing.'
- D. Try to ignore them and play cards with the others.'
Correct Answer: C
Rationale: The correct answer is C because it demonstrates active listening and empathy, which can help establish trust and rapport with the patient. By saying, "I'll stay with you. Tell me what you are hearing," the nurse acknowledges the patient's distress and offers support. This response can help the patient feel heard and understood, which is crucial in managing symptoms of schizophrenia.
Choice A is incorrect as it focuses more on the frequency rather than addressing the immediate distress. Choice B is incorrect as it assumes the patient has a plan to escape the voices, which may not be the case and can escalate the situation. Choice D is incorrect as it dismisses the patient's experience and suggests distraction rather than addressing the underlying issue.
A patient, aged 77 years, has Alzheimer's disease and lives with her daughter. While checking her blood pressure at the clinic, the nurse noticed fresh bruises on the patient's palms and buttocks. The patient could not explain these bruises. The nurse discussed her observations with the daughter, who became defensive and said that her mother was very difficult to manage. She stated, "My mother is getting worse every week. She is not my mother anymore. She can't recognize me, and she wanders all night. We take turns because she has to be watched constantly. Last night I fell asleep, and she fell down the stairs while wandering."Â Which statement is most accurate?
- A. Reporting the injuries in this case is not indicated by available data.
- B. The nurse should report the injuries as suggestive of elder abuse.
- C. The nurse is only required to report the injury if the patient is incompetent.
- D. The nurse is legally required to report the injuries as possible abuse.
Correct Answer: A
Rationale: Step 1: The nurse observed bruises on the patient's palms and buttocks.
Step 2: The patient could not explain these bruises.
Step 3: The daughter mentioned the patient's worsening condition and the incident of falling down the stairs.
Step 4: The daughter's statement indicates the patient's deteriorating cognitive and physical abilities.
Step 5: The daughter's challenges in managing the patient are due to the progression of Alzheimer's disease.
Step 6: There is no explicit evidence or indication of elder abuse based on the provided information.
Step 7: Reporting the injuries without clear signs of abuse may harm the patient's relationship with the daughter.
Step 8: Therefore, the most appropriate action is not to report the injuries based on the available data to avoid potential harm.
Summary:
- Choice A is correct as reporting the injuries is not indicated by the available data.
- Choices B, C, and D are incorrect as there is no clear evidence of elder abuse in the scenario
Retreat from reality by hallucinations and delusions and by social withdrawal typically characterizes
- A. somatoform disorders
- B. anxiety disorders
- C. psychotic disorders
- D. personality disorders
Correct Answer: C
Rationale: Psychotic disorders, like schizophrenia, involve hallucinations, delusions, and withdrawal, distinguishing them from other categories.
Which is a key nursing consideration when planning care for a patient with bulimia nervosa?
- A. Allow the patient to choose their preferred food options.
- B. Provide a structured environment with clear expectations around eating behaviors.
- C. Monitor for signs of weight gain and decrease calorie intake accordingly.
- D. Encourage the patient to participate in regular exercise routines.
Correct Answer: B
Rationale: The correct answer is B: Provide a structured environment with clear expectations around eating behaviors. This is important in managing bulimia nervosa as it helps establish a routine, promotes healthy eating habits, and prevents binge-purge cycles. It provides consistency and boundaries, reducing the likelihood of impulsive behaviors.
Incorrect choices:
A: Allowing the patient to choose their preferred food options can enable unhealthy eating patterns and reinforce disordered behaviors.
C: Monitoring for weight gain and decreasing calorie intake can worsen the patient's condition and perpetuate their obsession with weight and food.
D: Encouraging regular exercise routines may exacerbate the patient's unhealthy relationship with food and body image, leading to excessive exercising or compensatory behaviors.