Age Specific Patient Care

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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 emphasizes the importance of transitional objects like a blanket for young children to provide comfort and security as they develop a sense of self and separation from their primary caregiver. This theory aligns with the situation described, where the child's attachment to the blanket symbolizes the bond with the mother.

Explanation for why the other choices are incorrect:
B: Freud's developmental theory focuses on psychosexual stages and the role of unconscious processes, not specifically on transitional objects.
C: Kernberg's conceptualization of object constancy pertains to personality disorders and object relations in adult psychotherapy, not child development.
D: Sullivan's theory of 'good me' is about interpersonal relationships and self-esteem, not directly related to transitional objects in child development.

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A nurse assesses that which of the following individuals is most likely to engage in binge-eating behaviors characteristic of bulimia?

  • A. A person who weighs 225 pounds and is 5 feet 4 inches tall.
  • B. A person who is 5 pounds overweight and cannot stick to a diet.
  • C. A person who lost up 40 pounds but gained it back within 1 year.
  • D. A person who monitors caloric intake in order to fit into a small suit.
Correct Answer: B

Rationale: The correct answer is B because binge-eating behaviors are often associated with individuals who struggle to control their eating, leading to episodes of excessive food consumption. Being unable to stick to a diet indicates a lack of control, which is a key characteristic of binge-eating. Choice A focuses more on weight and height, which are not direct indicators of binge-eating. Choice C describes weight fluctuations, which may not necessarily be linked to binge-eating. Choice D emphasizes monitoring caloric intake for a specific goal, which does not necessarily indicate a loss of control over eating behavior.

The caregiver for a client with moderate to severe dementia tells the nurse, 'I'm exhausted. He wanders at night instead of sleeping, so I get no rest. I'm afraid to leave him during the day, so I have to take him to the grocery store and to the laundromat. When I'm busy there, he often wanders off. Still, I have to do it all.' The nurse recognizes the need to provide teaching for this caregiver. An appropriate outcome is that the caregiver will:

  • A. Feel justified in putting the client in a nursing home
  • B. Verbalize realistic self-expectations
  • C. Cease abusive interactions with the client
  • D. Feel comfortable leaving the client alone one morning a week
Correct Answer: B

Rationale: The correct answer is B: Verbalize realistic self-expectations. This is the most appropriate outcome to address the caregiver's situation. By verbalizing realistic self-expectations, the caregiver can understand the importance of self-care and setting boundaries. This outcome promotes the caregiver's well-being while still providing care for the client.

Choice A is incorrect because putting the client in a nursing home may not be the best solution without exploring other options first. Choice C is incorrect as there is no mention of abusive interactions in the scenario. Choice D is incorrect because feeling comfortable leaving the client alone without addressing the caregiver's exhaustion and concerns may not be the most appropriate approach.

Many persons brought before a criminal court have mental illness, have committed minor offenses, and are off medications. The judge consults the nurse at the local community mental health center for guidance about how to respond when handling such cases. Which advice from the nurse would be most appropriate?

  • A. Sometimes a little time in jail makes a person rethink what theyve been doing and puts them back on the right track.'
  • B. Sentencing such persons to participate in treatment instead of incarcerating them has been shown to reduce repeat offenses.'
  • C. Arresting these people helps them in the long run. Sometimes we cannot hospitalize them, but in jail they will get their medication.'
  • D. Research suggests that special mental health courts do not make much difference so far, but outpatient commitment does seem to help.'
Correct Answer: B

Rationale: Research supports the use of special mental health courts that can sentence mentally ill persons to treatment instead of jail. Jail exposes vulnerable mentally ill persons to criminals, victimization, and high levels of stimulation and stress. Incarceration can also interrupt eligibility for benefits or lead to the loss of housing and often provides lower-quality mental health treatment in other settings. Recidivism rates for both mentally ill and non-mentally ill offenders are relatively high, so it does not appear that incarceration necessarily leads people to behave more appropriately. In addition, a criminal record can leave them more desperate and with fewer options after release. Research indicates that outpatient commitment is less effective at improving the mental health of mentally ill persons than was expected.

A newly admitted patient diagnosed with paranoid schizophrenia is hypervigilant and constantly scans the environment. He states that he saw two doctors talking in the hall and knows they were plotting to kill him. When charting, how should the nurse identify this behavior?

  • A. Idea of reference
  • B. Delusion of infidelity
  • C. Auditory hallucination
  • D. Echolalia
Correct Answer: A

Rationale: The correct identification for the behavior described is "A: Idea of reference." This term refers to the belief that neutral events are directed at oneself. In this case, the patient's belief that the doctors were plotting to kill him is an example of a false idea of reference. Delusion of infidelity (choice B) involves false beliefs about a partner's unfaithfulness, not relevant here. Auditory hallucination (choice C) pertains to false perceptions of hearing sounds, not applicable. Echolalia (choice D) is the repetition of words spoken by others, not seen in this scenario. Identifying the behavior as an idea of reference helps the nurse understand the patient's distorted perception of reality.

Fragile X syndrome is associated with which of the following?

  • A. Language impairment
  • B. Behavioural problems
  • C. Moderate levels of intellectual disability
  • D. All of the above
Correct Answer: D

Rationale: Fragile X Syndrome: A chromosomal abnormality causing intellectual disability, language impairment, and behavioral issues.

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