Nokea
The experienced nurse assessing a battered woman client uses many open-ended questions during the interview. The rationale for this is that:
- A. The woman will feel more in charge of the interview
- B. Such questions allow for simple yes or no answers when the client is upset
- C. The questions are direct and easily understood by anxious individuals
- D. Clients can refuse to answer when sensitive information is being probed
Correct Answer: A
Rationale: The correct answer is A because using open-ended questions allows the client to express themselves freely, promoting a sense of control and empowerment. This approach helps build trust and rapport, enabling the client to share their experiences more openly. Choice B is incorrect because closed-ended questions limit the client's ability to fully express themselves. Choice C is incorrect as open-ended questions encourage deeper reflection and discussion, which may not be easily understood by anxious individuals. Choice D is incorrect because while clients can refuse to answer sensitive questions, open-ended questions actually encourage them to share more, rather than withhold information.
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The outcome that should be established for an elderly patient with delirium caused by fever and dehydration is that the patient will:
- A. Return to a premorbid level of functioning.
- B. Demonstrate motor responses to noxious stimuli.
- C. Identify stressors negatively affecting self.
- D. None of the above.
Correct Answer: A
Rationale: The correct answer is A because the goal in managing delirium in an elderly patient is to restore them to their premorbid level of functioning. This involves addressing the underlying causes like fever and dehydration. Option B is incorrect as it focuses on a neurological response rather than the overall outcome for the patient. Option C is also incorrect as it pertains to identifying stressors, which is not the primary goal in managing delirium. Option D is incorrect as it dismisses the importance of restoring the patient to their baseline level of functioning.
A patient being treated for major depression is the CEO of her own business. She has shown significant improvement and is about to be discharged after completing a course of 15 electroconvulsive therapy sessions. She will continue on SSRI medications. The patient has been counseled not to make a major business decision for a month. The rationale for this is that:
- A. SSRIs may cause confusion in susceptible persons.
- B. ECT often causes temporary memory impairment.
- C. Lingering depression makes the patient incompetent.
- D. The patient needs months to readjust to work pressures.
Correct Answer: B
Rationale: The correct answer is B: ECT often causes temporary memory impairment. This is because electroconvulsive therapy (ECT) is known to have side effects, including temporary memory loss and confusion. As the patient has just completed a course of 15 ECT sessions, it is important to allow time for the effects of ECT to subside before making major decisions, especially in a high-pressure role like being a CEO. Choices A and C are incorrect as SSRIs do not typically cause confusion and lingering depression alone does not necessarily make a patient incompetent. Choice D is incorrect as there is no indication that the patient needs months to readjust to work pressures; the primary concern here is the potential memory impairment from ECT.
A nurse and social worker co-lead a reminiscence group for eight old-old and centenarian adults. Which activity is appropriate to include in the group?
- A. Mild aerobic exercise
- B. Singing a song from World War II
- C. Discussing national leadership during the Vietnam War
- D. Identifying the most troubling story in today's newspaper
Correct Answer: B
Rationale: The correct answer is B: Singing a song from World War II. This activity is appropriate because reminiscence therapy involves recalling past memories to enhance well-being in older adults. Singing a song from that era can help trigger positive emotions and memories for the participants.
A: Mild aerobic exercise may not be suitable for all participants due to physical limitations.
C: Discussing national leadership during the Vietnam War might evoke negative emotions or political disagreements.
D: Identifying the most troubling story in today's newspaper could lead to distress and is not conducive to the therapeutic nature of reminiscence therapy.
The family of a patient with schizophrenia who has been stable for a year reports to the community mental health nurse that the patient reports feeling tense and having difficulty concentrating. He sleeps only 3 to 4 hours nightly and has begun to talk about creatures called 'volmers' hiding in the warehouse where he works and undoing his work each night. This information most likely suggests:
- A. medication nonadherence.
- B. a need for psychoeducation.
- C. the chronic nature of his illness.
- D. relapse of his schizophrenia.
Correct Answer: D
Rationale: The correct answer is D: relapse of his schizophrenia. The patient's symptoms of feeling tense, difficulty concentrating, poor sleep, and delusional beliefs about creatures at work indicate a worsening of his psychotic symptoms. This suggests a relapse of schizophrenia, a chronic mental illness characterized by periods of stability and exacerbation of symptoms. The patient's previous stability for a year makes medication nonadherence less likely. While psychoeducation may be beneficial, the patient's current symptoms require more immediate intervention for relapse management. The information provided does not directly indicate the chronic nature of his illness, but rather an acute exacerbation. Therefore, D is the most appropriate choice based on the presented symptoms and clinical understanding of schizophrenia.
A client has been admitted with disorganized type schizophrenia. The nurse observes blunted affect and social isolation. The client occasionally curses or calls another client a 'jerk' without provocation. The nurse asks the client how he is feeling, and he responds, 'Everybody picks on me. They frobitz me.' The best response for the nurse to make would be:
- A. That's really too bad.'
- B. Who do you mean when you say 'everybody'?'
- C. What difference does frobitzing make?'
- D. Why do they frobitz?'
Correct Answer: B
Rationale: The correct answer is B: "Who do you mean when you say 'everybody'?"
Rationale:
1. Clarifying the client's statement helps to understand his perception.
2. Asking specifically about 'everybody' encourages the client to express his feelings and thoughts.
3. It promotes therapeutic communication by showing empathy and active listening.
Incorrect choices:
A: "That's really too bad." - This response does not address the client's specific concerns or promote further exploration.
C: "What difference does frobitzing make?" - This response is dismissive and lacks empathy or understanding of the client's experience.
D: "Why do they frobitz?" - This response is confrontational and may come across as accusatory, potentially shutting down communication.