Nokea
The affective losses of Alzheimer's disease refer to losses noticed in the individual's:
- A. Personality
- B. Thought processes
- C. Ability to make and carry out plans
- D. Self-care
Correct Answer: A
Rationale: The affective losses of Alzheimer's disease refer to changes in emotions and mood, impacting personality traits. This is because the disease affects areas of the brain responsible for regulating emotions. Personality changes are commonly observed in individuals with Alzheimer's. Thought processes (choice B) are more related to cognitive decline, while ability to make and carry out plans (choice C) and self-care (choice D) are more associated with functional decline. Therefore, choice A is correct as it specifically addresses the affective aspect of the disease.
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A female client with a psychotic disorder is experiencing olfactory hallucinations. Most likely, she would be complaining of:
- A. A vision that is disturbing to her
- B. A sound that is disturbing to her
- C. A smell that is disturbing to her
- D. A sense of touch that is disturbing to her
Correct Answer: C
Rationale: The correct answer is C because olfactory hallucinations involve perceiving smells that are not actually present. In a psychotic disorder, such hallucinations are common and can be disturbing to the individual. This is due to the sensory perception of smells that others cannot detect. Choices A, B, and D do not align with the experience of olfactory hallucinations. Vision (A) and sound (B) are not related to olfactory hallucinations, and a sense of touch (D) is not typically associated with this type of sensory distortion in psychotic disorders.
A nurse would assess for which feature in a patient diagnosed with bulimia nervosa?
- A. Introverted personality traits
- B. Abuse of diuretics and laxatives
- C. Disinterest in sexual activity
- D. Denial of hunger at all times
Correct Answer: B
Rationale: The correct answer is B because abuse of diuretics and laxatives is a common behavior in individuals with bulimia nervosa to control weight. This behavior is known as purging. Choice A is incorrect as personality traits vary among individuals with bulimia nervosa. Choice C is incorrect as disinterest in sexual activity is not a typical feature of this disorder. Choice D is incorrect as individuals with bulimia nervosa often experience episodes of binge eating, indicating they do experience hunger at times.
Which measure is critical to achieving desired outcomes in the nurse-client relationship? The nurse:
- A. develops trust in the client.
- B. uses autodiagnosis.
- C. relies on the client liking the nurse rather than limit-setting to achieve structure.
- D. analyzes the relationships among biologic, familial, and sociocultural factors that contributed to the client's disorder.
Correct Answer: B
Rationale: The correct answer is B: uses autodiagnosis. Autodiagnosis is critical in the nurse-client relationship as it involves self-awareness and reflection by the nurse to understand their own biases, emotions, and reactions. This self-awareness allows the nurse to effectively manage their responses, maintain professionalism, and provide quality care to the client. By being aware of their own thoughts and feelings, nurses can better empathize with the client, build trust, and communicate effectively. This approach helps prevent potential conflicts and misunderstandings, leading to better outcomes in the nurse-client relationship.
Summary:
A: Developing trust in the client is important but not the most critical measure.
C: Relying on the client liking the nurse is not professional and may compromise boundaries.
D: Analyzing biologic, familial, and sociocultural factors is important but not as critical as self-awareness through autodiagnosis.
Select the best comment for a nurse to begin an interview with an elderly patient.
- A. I am a nurse. Are you familiar with what nurses do?
- B. Hello. I am going to ask you some questions to get to know you better.
- C. You look comfortable and ready to participate in an admission interview. Shall we get started?
- D. Hello. My name is_____ and I am a nurse. How you would like to be addressed by staff?
Correct Answer: D
Rationale: The correct answer is D because it establishes the nurse's identity and shows respect by asking the patient's preference for addressing them. This approach sets a positive tone and promotes patient-centered care. Option A is incorrect as it assumes the patient's familiarity with nurses. Option B lacks professionalism and fails to acknowledge the purpose of the interview. Option C assumes the patient's readiness without confirming it directly and may come off as presumptuous.
The physician's admission note mentions that a patient has sundown syndrome. The nurse can expect that the patient will:
- A. exhibit chronic fatigue.
- B. evidence extreme lethargy at night.
- C. manifest confusion and agitation at night.
- D. be more alert between 6 PM and 11 PM.
Correct Answer: C
Rationale: The correct answer is C: manifest confusion and agitation at night. Sundown syndrome refers to a pattern of behavior where individuals with dementia experience increased confusion, agitation, or restlessness in the late afternoon or evening. This is due to disruptions in the person's internal body clock. It is important for the nurse to anticipate and manage these symptoms during the evening shift.
Choice A: Chronic fatigue is not a typical symptom of sundowning.
Choice B: Extreme lethargy at night is not a common feature of sundown syndrome.
Choice D: Being more alert between 6 PM and 11 PM is not characteristic of sundowning, as individuals with this syndrome typically experience worsening symptoms during these hours.