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The client admitted for uncontrolled diabetes is worried about how to pay bills for the family while hospitalized. Which statement by the nurse is therapeutic?
- A. "You are worried about paying your bills?"
- B. "Don't worry; your bills will get paid eventually."
- C. "When was the last time you were admitted for hyperglycemia?"
- D. "You really shouldn't be drinking alcohol because of your diagnosis of diabetes."
Correct Answer: A
Rationale: The therapeutic communication technique used in this scenario is reflection. By repeating the client's concern, the nurse acknowledges the client's feelings and encourages further exploration of the topic. Choice A is correct as it reflects the client's worry without offering false assurance, advice, or using professional jargon. Choice B dismisses the client's concerns with false reassurance. Choice C introduces professional jargon, which may hinder effective communication. Choice D provides advice, which can limit the client's expression of feelings and concerns.
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Which signs and symptoms would the nurse observe in a client with schizophrenia?
- A. Traumatic flashbacks and hypervigilance
- B. Depression and psychomotor retardation
- C. Loosened associations and hallucinations
- D. Ritualistic behavior and obsessive thinking
Correct Answer: C
Rationale: In clients with schizophrenia, the nurse would observe loosened associations and hallucinations. Loosened associations refer to disorganized thinking where thoughts are not logically connected. Hallucinations involve perceiving things that are not based in reality. Traumatic flashbacks and hypervigilance are more indicative of post-traumatic stress disorder. Depression and psychomotor retardation are common in depression, not schizophrenia. Ritualistic behavior and obsessive thinking are typically seen in obsessive-compulsive disorders, not schizophrenia.
On her first visit to the neonatal intensive care unit to see her preterm newborn, the mother's only comment to the nurse is, 'My baby looks so fragile. Do you think my child will make it?' Which is the most appropriate response by the nurse?
- A. "Many infants born as small as yours have done just fine."
- B. "The staff is confident in your child's prognosis because preterm babies do look like this at first."
- C. "It's understandable that your baby looks fragile to you. What have you learned about the condition?"
- D. "Your baby is not as fragile as it appears. Do you find it so frightening that you can't touch your child?"
Correct Answer: C
Rationale: The nurse's response should aim to convey acceptance and encourage the mother to express her concerns. By saying, "It's understandable that your baby looks fragile to you. What have you learned about the condition?", the nurse acknowledges the mother's feelings and prompts her to share her understanding, fostering further communication and addressing any misconceptions. Choices A and B dismiss the mother's concerns by making general statements and do not encourage dialogue. Choice D implies judgment and may deter the mother from opening up about her fears.
During a scheduled health maintenance visit, which common source of stress for a 6-year-old client would the nurse include in the teaching session?
- A. Wanting to be first
- B. Demanding privacy
- C. Having a desire to be like an idol
- D. Being more selective with playmates
Correct Answer: A
Rationale: A common source of stress for a 6-year-old school-age client is competition, such as wanting to be first or the best (winning). This aspect can create stress for a 6-year-old as they navigate social interactions and activities. Therefore, the nurse would address this issue during the teaching session at the health maintenance visit. Demanding privacy, having a desire to be like an idol, and being more selective with playmates are characteristics more commonly associated with 7-year-old clients, not typically seen in the stressors of a 6-year-old. Understanding age-appropriate stressors is crucial for providing tailored education and support in pediatric care.
Which of the following is a typical assessment finding of a 24-year-old female with anorexia nervosa?
- A. Weight loss of more than 2% body fat
- B. Frequent binge-eating episodes followed by induced vomiting
- C. A history of poor academic performance and mediocre achievements
- D. Lack of menstruation
Correct Answer: D
Rationale: The correct answer is D: Lack of menstruation. Amenorrhea, or lack of menstruation, is a common occurrence in individuals with anorexia nervosa. The induced starvation from anorexia can disrupt hormone levels, leading to menstrual irregularities. This hormonal imbalance can result in amenorrhea, which can have long-term consequences such as osteoporosis and infertility. Choices A, B, and C are incorrect. Weight loss of more than 2% body fat may be a consequence of anorexia but is not a specific assessment finding. Frequent binge-eating episodes followed by induced vomiting are more characteristic of bulimia nervosa, not anorexia nervosa. A history of poor academic performance and mediocre achievements is not a typical assessment finding related to anorexia nervosa symptoms.
Which characteristic is associated with anorexia nervosa?
- A. Manic
- B. Rebellious
- C. Hypoactive
- D. Perfectionistic
Correct Answer: D
Rationale: Individuals with anorexia nervosa often exhibit perfectionistic traits, characterized by rigid standards and extreme self-discipline as a way to maintain control and fulfill personal and societal expectations. The focus on achieving an ideal body image through strict dietary habits and excessive exercise is a common manifestation of this perfectionism. The incorrect choices are: A) 'Manic' is not typically associated with anorexia nervosa; individuals with this disorder are more likely to experience anxiety and depression. B) 'Rebellious' does not align with the usual behavior seen in individuals with anorexia nervosa, who tend to comply with societal expectations rather than rebel against them. C) 'Hypoactive' does not describe the characteristic behavior of individuals with anorexia nervosa, who often engage in excessive physical activity as a means of weight loss.