The client has become unable to recognize formerly familiar objects and people in his environment. The client is experiencing:
- A. Affect "“ experienced feelings and emotions
- B. Agnosis "“ inability to recognize familiar objects or people
- C. Apraxia "“ difficulty carrying out purposeful, organized task that is somewhat complex (ex. dressing)
- D. Anhedonia "“ lack of pleasure
Correct Answer: B
Rationale: The correct answer is B: Agnosis - inability to recognize familiar objects or people. This is because the client's inability to recognize formerly familiar objects and people in his environment aligns with the definition of agnosis. Affect (choice A) refers to experienced feelings and emotions, which is not the issue described in the question. Apraxia (choice C) is difficulty carrying out purposeful tasks, not related to recognition of objects or people. Anhedonia (choice D) is a lack of pleasure, which is also not applicable to the client's situation. Therefore, the best fit for the client's experience is agnosis.
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The nurse manager of a mental health center wants to improve medication adherence among the seriously mentally ill persons treated there. Which interventions are likely to help achieve this goal? Select one tha does not apply
- A. Maintain stable and consistent staff
- B. Increase the length of medication education groups
- C. Stress that without treatment, illnesses will worsen
- D. Prescribe drugs in smaller but more frequent dosages
Correct Answer: A
Rationale: Trust in ones providers is a key factor in treatment adherence, and mentally ill persons can sometimes take a very long time to develop such trust; therefore, interventions which stabilize staffing allow patients to have more time with staff to develop these bonds. Ready access to prescribers allows medicine-related concerns to be addressed quickly, reducing obstacles to adherence such as side effects or ineffective dosages. Medication costs can be obstacles to adherence as well. Many SMI patients have anosognosia and do not adhere to treatment because they believe they are not ill, so telling them nonadherence will worsen an illness they do not believe they have is unlikely to be helpful. Increasing medication education is helpful only when the cause of nonadherence is a knowledge deficit. Other issues that reduce adherence, particularly anosognosia and side effects, are seldom helped by longer medication education. Requiring medication adherence to participate in other programs is coercive and unethical. Smaller, more frequent doses do not reduce side effects and make the regimen more difficult for the patient to remember.
A patient, aged 82 years, has Alzheimer's disease. She lives with her daughter's family and goes to a day care facility on weekdays. The nurse at the day care center noticed the patient was unkempt and had multiple bruises. When the daughter arrived to pick her up, the nurse discussed her observations. The daughter became defensive and said that her mother was very difficult to manage. She stated, "My mother is not my mother anymore. She is confused, and she wanders all night. We have to watch her constantly. Last night I fell asleep, and she fell down the stairs. Sometimes I just cannot bear to care for her."Â Which nursing diagnosis would be most important to address for this patient?
- A. Risk for injury related to impaired cognition, judgment, and coordination and lack of caregiver supervision
- B. Nonadherence related to confusion and disorientation, as evidenced by lack of cooperation
- C. Anxiety related to increasing disorientation, as evidenced by the patient wandering at night
- D. Impaired verbal communication related to brain impairment, as evidenced by the patient's confusion
Correct Answer: A
Rationale: The correct answer is A: Risk for injury related to impaired cognition, judgment, and coordination and lack of caregiver supervision. The rationale is that the patient's Alzheimer's disease has led to impaired cognitive function, making her at risk for injury due to wandering and falls. The daughter's lack of supervision and inability to manage the patient's needs further exacerbate this risk. Choices B, C, and D are incorrect because they do not directly address the immediate safety concern of the patient being at risk for injury. Nonadherence, anxiety, and impaired communication are important issues but do not take precedence over the patient's safety in this context.
A client with a borderline personality disorder tells the nurse, 'My doctor tells me there's something wrong with the hard wiring of my brain, and that's why I'm so impulsive and get so many mood swings. He said he's going to prescribe some medication.' Being aware of current practice guidelines, the nurse will prepare a teaching plan for:
- A. Lithium
- B. Fluoxetine
- C. Lorazepam
- D. Haloperidol
Correct Answer: B
Rationale: The correct answer is B: Fluoxetine. In the context of borderline personality disorder, fluoxetine, a selective serotonin reuptake inhibitor (SSRI), is often used to manage symptoms such as mood swings and impulsivity. SSRIs help regulate serotonin levels in the brain, which can improve mood stability and reduce impulsive behaviors.
- A: Lithium is typically used for bipolar disorder, not borderline personality disorder.
- C: Lorazepam is a benzodiazepine used for anxiety or panic disorders, not specific to treating symptoms of borderline personality disorder.
- D: Haloperidol is an antipsychotic medication used for psychosis, not typically indicated for managing impulsivity or mood swings in borderline personality disorder.
What is the most appropriate goal for a nurse caring for a patient with anorexia nervosa?
- A. The patient will gain weight rapidly to achieve a normal weight.
- B. The patient will stabilize their weight and maintain adequate nutrition.
- C. The patient will achieve full recovery without needing additional support.
- D. The patient will accept their body image as normal and healthy.
Correct Answer: B
Rationale: The most appropriate goal for a nurse caring for a patient with anorexia nervosa is for the patient to stabilize their weight and maintain adequate nutrition (Choice B). This goal is crucial because rapid weight gain can have negative physical and psychological consequences for the patient. Stabilizing weight helps prevent complications like refeeding syndrome and supports the patient's overall health. It also addresses the immediate nutritional needs of the patient. Choices A, C, and D are incorrect because rapid weight gain can be harmful, full recovery often requires ongoing support, and body image acceptance may not be the most pressing concern for someone with anorexia nervosa.
An individual is seeking treatment for bulimia nervosa. The therapist decides to use cognitive behavioral therapy and medication. For what medication can a nurse expect to develop a patient education program?
- A. A selective serotonin reuptake inhibitor (SSRI).
- B. Lithium.
- C. Acamprosate.
- D. A benzodiazepine.
Correct Answer: A
Rationale: The correct answer is A: A selective serotonin reuptake inhibitor (SSRI). SSRIs are commonly used in treating bulimia nervosa due to their effectiveness in reducing binge eating and purging behaviors. They work by increasing serotonin levels in the brain, which helps regulate mood and appetite control. A nurse would develop a patient education program for SSRIs to explain their mechanism of action, potential side effects, how to take them correctly, and the importance of compliance.
Summary:
- Lithium is not typically used for bulimia nervosa and is more commonly used for bipolar disorder.
- Acamprosate is used for alcohol dependence, not bulimia nervosa.
- Benzodiazepines are not indicated for bulimia nervosa and are typically used for anxiety disorders or insomnia.