Nokea
Joey is a 5-year-old who is causing his parents a lot of concern. His mother reports that he bounces off the walls all the time and cant focus on any one thing for very long. He is impulsive and has recently ran right out into the street in front of the familys home. His teacher has told his parents that he has done similar things at school. The nurse understands that:
- A. Joey shows all the signs of having ADHD and should probably be placed on Ritalin as soon as possible
- B. Joey is just an active, healthy child who needs to be disciplined more effectively
- C. Joey could be autistic, and additional testing will have to be done to confirm the diagnosis
- D. Joey shows signs of having ADHD, but is too young for that diagnosis to be made definitively now
Correct Answer: D
Rationale: Definitive diagnosis of ADHD should not be made before age 7 because developmentally the child has a shorter attention span.
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A client with schizophrenia tells the nurse that he is the President of the United States, and no logical reasoning with the client convinces him otherwise. This client is experiencing a:
- A. Mutism
- B. Delusion
- C. Neologism
- D. Flight of ideas
Correct Answer: B
Rationale: The correct answer is B: Delusion. A delusion is a fixed false belief that is not based on reality, such as believing one is a famous figure like the President. In this scenario, the client's belief is firmly held despite evidence to the contrary, indicating a delusion. Mutism (A) is a lack of verbal communication, not applicable here. Neologism (C) is creating new words or phrases, not seen in this example. Flight of ideas (D) is a rapid, continuous flow of speech with abrupt topic changes, which is not demonstrated in the client's behavior described.
A teacher comes to the mental health clinic saying a co-worker recently confronted her about behaviors that are annoying to other co-workers. She is now experiencing moderate to severe levels of anxiety. The co-worker told the patient that others find her very difficult because she is a perfectionist and micromanages the tasks of others on the teaching team, always demanding that things should be done according to her plans. The co-worker mentioned that the patient made everyone feel as though everything they tried was inadequate, and they feel frustrated and angry. The patient states she likes her co-workers and only wanted to help them be successful. The nurse realizes the patient's behaviors are most consistent with:
- A. obsessive-compulsive personality disorder.
- B. narcissistic personality disorder.
- C. histrionic personality disorder.
- D. schizoid personality disorder.
Correct Answer: A
Rationale: The correct answer is A: obsessive-compulsive personality disorder. This is because the patient's behaviors of being a perfectionist, micromanaging tasks, demanding things be done according to her plans, and making others feel inadequate align with the diagnostic criteria for obsessive-compulsive personality disorder. Individuals with this disorder are preoccupied with orderliness, perfectionism, and control.
Choice B: narcissistic personality disorder, is incorrect because the patient's behaviors are not characterized by a sense of grandiosity, a lack of empathy, or a need for admiration, which are hallmark features of narcissistic personality disorder.
Choice C: histrionic personality disorder, is incorrect as individuals with this disorder typically display attention-seeking behavior, emotional instability, and excessive emotionality, none of which are evident in the patient's presentation.
Choice D: schizoid personality disorder, is incorrect as individuals with this disorder tend to be socially detached, have limited emotional expression, and prefer solitary activities, which do not align with the
A nurse would conclude that a patient with an eating disorder is exhibiting a cognitive distortion after hearing the patient make which statement?
- A. I see now that I need to establish my own preferences and routines.'
- B. Bingeing makes my feelings of both isolation and loneliness go away.'
- C. Controlling what I eat has been a way for me to exert control over my life.'
- D. I need to watch for hunger and fatigue as triggers for my eating disorder.'
Correct Answer: B
Rationale: The correct answer is B because the statement reflects emotional reasoning, a common cognitive distortion in eating disorders. The patient believes that bingeing is an effective way to cope with feelings of isolation and loneliness, which is not a healthy or rational belief. This cognitive distortion can perpetuate the cycle of disordered eating behavior.
A: This choice shows a healthy realization and decision-making process, indicating a positive step towards recovery.
C: While controlling food intake may be a coping mechanism, it doesn't necessarily indicate a cognitive distortion.
D: This choice demonstrates awareness of triggers, which is important for managing the disorder, but it doesn't necessarily indicate a cognitive distortion.
A salesman has had difficulty holding a job because he accuses co-workers of conspiring to take his sales. Today, he argued with several office mates and threatened to kill one of them. The police were called, and he was brought to the mental health center for evaluation. He has had previous admissions to the unit for stabilization of paranoid schizophrenia. When the nurse meets him, he points at staff in the nursing station and states loudly, 'They're all plotting to destroy me. Isn't that true?' Which would be the most appropriate response?
- A. No, that is not true. People here are trying to help you if you will let them.'
- B. Let's think about it: what reason would people have to want to destroy you?'
- C. Thinking that people want to destroy you must be very frightening.'
- D. That doesn't make sense; staff are health care workers, not murderers.'
Correct Answer: C
Rationale: The correct answer is C: Thinking that people want to destroy you must be very frightening.
Rationale:
1. Acknowledges the patient's feelings: By stating that thinking people want to destroy him is frightening, the nurse shows empathy and validates his experience.
2. Validates the patient's emotions: This response does not directly agree or disagree but acknowledges the emotions behind the patient's statement.
3. Builds rapport: By showing understanding and empathy, the nurse can establish trust and rapport with the patient, leading to better communication and therapeutic relationship.
Summary of other options:
A: This response denies the patient's feelings and could potentially escalate the situation by invalidating his experiences.
B: This response may come off as confrontational and does not address the patient's underlying fears.
D: This response is dismissive and does not address the patient's emotional distress, potentially leading to further agitation.
Which is a hallmark characteristic of bulimia nervosa?
- A. Persistent restriction of caloric intake.
- B. Binge eating followed by purging behaviors.
- C. Severe weight loss due to food refusal.
- D. Excessive exercising to burn calories.
Correct Answer: B
Rationale: The correct answer is B because bulimia nervosa is characterized by recurrent episodes of binge eating followed by compensatory behaviors such as purging. Binge eating involves consuming a large amount of food in a short period, followed by feelings of loss of control. Purging behaviors like self-induced vomiting or misuse of laxatives are used to prevent weight gain. Choices A, C, and D are incorrect because bulimia nervosa typically involves normal or fluctuating weight, not severe weight loss or excessive exercise to burn calories. Persistent restriction of caloric intake is more indicative of anorexia nervosa, not bulimia nervosa.