Age Specific Care Competency

Age Specific Care Competency Related

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The mother of a 2-year-old tells the nurse at the well-child clinic that her child likes to take a blanket wherever he goes. The mother asks if she should take the blanket away from the child. The nurse counsels the mother to allow the child to have the blanket because it reminds him of his mother and comforts him. The basis for this counseling is:

  • A. Mahler's theory of object relations
  • B. Freud's developmental theory
  • C. Kernberg's conceptualization object constancy
  • D. Sullivan's theory of 'good me'
Correct Answer: A

Rationale: The correct answer is A: Mahler's theory of object relations. Mahler's theory focuses on the development of a child's sense of self and relationships. In the scenario provided, the child's attachment to the blanket can be seen as a transitional object, which is a source of comfort and security, similar to the mother. This concept aligns with Mahler's theory that objects like blankets can serve as symbols of the mother and aid in the child's emotional development.

Incorrect choices:
B: Freud's developmental theory primarily focuses on psychosexual stages of development, which do not directly address the use of transitional objects.
C: Kernberg's conceptualization of object constancy pertains to personality disorders and the ability to maintain stable relationships, not the use of transitional objects.
D: Sullivan's theory of 'good me' is centered around interpersonal relationships and self-esteem, which are not directly related to the use of transitional objects in early childhood development.

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In addition to antidepressants, which of the following is usual treatment for postpartum depression?

  • A. Antipsychotics
  • B. Psychotherapy
  • C. Hormone replacement
  • D. Temporary removal of the baby from the home
Correct Answer: B

Rationale: Psychotherapy (B) along with antidepressants are the major treatments for postpartum depression. Patients usually are not psychotic (A), hormone replacement (C) is not indicated, and mother and baby should be kept together with support (D).

A 38-year-old woman, who had a subtotal thyroidectomy 8 years previously, is again thyrotoxic. Which one of the following is the most appropriate management?

  • A. Perform total thyroidectomy after preparation with carbimazole.
  • B. Radioactive iodine after preparation with oral iodine treatment.
  • C. Prescribe immunosuppressive treatment with azathioprine.
  • D. Control with cardimazole and then administration of radioactive iodine.
Correct Answer: D

Rationale: Recurrent thyrotoxicosis post-subtotal thyroidectomy is best managed with carbimazole to control symptoms, followed by radioactive iodine (D) for definitive treatment. Total thyroidectomy (A) is more invasive, iodine alone (B) is incorrect, immunosuppression (C) is irrelevant, and beta-blockers (E) are symptomatic only.

A client with obsessive-compulsive personality disorder seeks treatment for depression after the recent breakup of a relationship. The client constantly procrastinated about proposing marriage and said his girlfriend complained that he did not show her affection and that he was too controlling. Now he describes inability to sleep, poor concentration, and loss of energy since the breakup. Which outcome is a priority for the client? The client will:

  • A. Demonstrate assertive behavior
  • B. Express hope for developing a new relationship in the future
  • C. Identify feelings of sadness related to the failed relationship
  • D. List three new ways to reduce stress
Correct Answer: C

Rationale: Rationale: The correct answer is C: Identify feelings of sadness related to the failed relationship. This is the priority outcome because the client is experiencing symptoms of depression following the breakup, such as insomnia, poor concentration, and loss of energy. By identifying and processing the feelings of sadness related to the failed relationship, the client can begin to work through the grief and start the healing process.

Summary:
A: Demonstrating assertive behavior may be beneficial for the client in the long term but is not the priority at this stage when dealing with depression.
B: Expressing hope for a new relationship may provide temporary relief but does not address the underlying issues of depression and unresolved feelings from the breakup.
D: Listing new ways to reduce stress is important for overall well-being but does not address the primary concern of processing feelings of sadness and grief related to the failed relationship.

A client with catatonic schizophrenia has been posturing, standing with his left arm upraised and his right foot off the floor. For the most part, he ignores attempts at nursing intervention but will occasionally walk, sit, or lie down for a few minutes. The client eats standing up if the nurse brings a tray to the room. The priority nursing order would be to:

  • A. Insist that client sit or lie down for 30 minutes hourly
  • B. Assess for lower extremity edema bid
  • C. Provide high-calorie drinks hourly
  • D. Take client to activities therapy once daily
Correct Answer: B

Rationale: The correct answer is B. Assess for lower extremity edema bid.

Rationale:
1. Priority is to assess for lower extremity edema as the client is standing for extended periods, which can lead to edema.
2. Edema assessment is crucial for preventing complications like blood clots or skin breakdown.
3. Insisting on sitting or lying down may aggravate the client and worsen the situation.
4. Providing high-calorie drinks or activities therapy are not the immediate priority in this case.

In summary, assessing for lower extremity edema is crucial due to the client's prolonged standing, which can lead to potential health risks, making it the priority nursing order.

What is an important aspect of managing refeeding syndrome in patients with anorexia nervosa?

  • A. Refeeding the patient with high-calorie foods immediately.
  • B. Monitoring electrolytes closely during the refeeding process.
  • C. Allowing the patient to eat whatever they want without restrictions.
  • D. Restricting fluid intake to avoid water retention.
Correct Answer: B

Rationale: The correct answer is B because monitoring electrolytes closely during refeeding is crucial to prevent life-threatening complications such as electrolyte imbalances. Refeeding syndrome can lead to shifts in electrolytes, particularly phosphorus, potassium, and magnesium, which may result in cardiac arrhythmias, respiratory failure, or even death. Close monitoring allows for timely interventions to maintain electrolyte balance.

Choice A is incorrect because refeeding a patient with high-calorie foods immediately can actually exacerbate refeeding syndrome by overwhelming the body's metabolic and electrolyte regulation processes. Choice C is incorrect because allowing the patient to eat whatever they want without restrictions can lead to rapid and uncontrolled weight gain, which may worsen medical complications. Choice D is incorrect because restricting fluid intake can also contribute to electrolyte imbalances and dehydration during refeeding.

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