Nokea
In refeeding syndrome that develops during nutritional rehabilitation of a patient with eating disorder, what is the most important biochemical change?
- A. Hypomagnesemia
- B. Hypophosphatemia
- C. Hypokalaemia
- D. Hypoglycaemia
Correct Answer: B
Rationale: Hypophosphatemia is the most critical biochemical change in refeeding syndrome, as it can lead to severe complications like cardiac arrest.
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Which finding for a patient with an eating disorder most clearly indicates the need for hospitalization?
- A. Weight 15% below ideal weight
- B. Urine output less than 30 mL/hr
- C. Serum potassium 3.4 mEq/L
- D. Pulse rate 54 beats/min
Correct Answer: B
Rationale: The correct answer is B because urine output less than 30 mL/hr indicates severe dehydration and compromised kidney function, which can lead to organ failure. Hospitalization is necessary for immediate fluid resuscitation and monitoring. Option A is indicative of malnutrition but does not directly signify acute medical complications. Option C suggests hypokalemia, which can be managed on an outpatient basis. Option D, a low pulse rate, may be a sign of bradycardia but typically does not require immediate hospitalization unless accompanied by other severe symptoms.
A patient with schizophrenia tells the nurse 'I don't know, it's just all the same. You never know. It comes, it goes, it blows away. Get it?' The best response for the nurse to make would be:
- A. Nothing you are saying is clear; you are not making sense.'
- B. Yes, life can be like that sometimes, very confusing.'
- C. Try to organize your thoughts and then tell me again.'
- D. I am having difficulty understanding what you are saying.'
Correct Answer: D
Rationale: The correct answer is D because it reflects active listening and acknowledges the patient's communication difficulties without being dismissive. By stating difficulty in understanding, the nurse shows empathy and openness to further clarification. Choice A is incorrect as it may be perceived as judgmental. Choice B is incorrect as it does not address the patient's communication challenges. Choice C is incorrect as it places the responsibility solely on the patient without offering support.
Which statement by a patient with bulimia nervosa indicates a need for further education?
- A. I understand that purging can damage my body in the long term.
- B. I feel better after purging, but I know it's not a healthy behavior.
- C. I believe I can control my eating and purging behaviors without help.
- D. I know I need therapy to address my unhealthy relationship with food.
Correct Answer: C
Rationale: Rationale:
Choice C indicates a need for further education because it suggests the patient believes they can manage bulimia without help. Patients with bulimia often require professional intervention for successful treatment. Choices A, B, and D acknowledge the need for therapy, understanding of long-term consequences, and recognition of unhealthy behaviors, respectively.
In Massachusetts, which year contained the highest level of days exceeding the 8-hour average ground-level ozone standard?
- A. 1983
- B. 1984
- C. 2007
- D. 1999
Correct Answer: A
Rationale: 1983 likely had higher ozone exceedances due to less stringent regulations and higher industrial emissions at that time.
Which of the following interventions is most appropriate for a patient with bulimia nervosa?
- A. Encourage regular weight monitoring and restriction of food intake.
- B. Offer emotional support and focus on healthy coping mechanisms.
- C. Provide medications to induce vomiting after meals.
- D. Focus on achieving weight loss and reducing food intake.
Correct Answer: B
Rationale: The correct answer is B because offering emotional support and focusing on healthy coping mechanisms are crucial in treating bulimia nervosa. This approach addresses the psychological aspects of the disorder and helps the patient develop healthier behaviors. Regular weight monitoring and food restriction (choice A) can exacerbate the disorder by reinforcing a focus on weight and food. Medications to induce vomiting (choice C) can be harmful and do not address the underlying issues. Focusing on weight loss and reducing food intake (choice D) may worsen the patient's disordered eating behaviors and contribute to a cycle of restriction and bingeing.