Population Based Care

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The nurse in the emergency department tells the daughter of a patient that her 86-year-old mother has had a stroke. The daughter tearfully asks the nurse, 'Who will take care of me now?' When the nurse explores this query, the daughter mentions that her mother always tells her what job to take, what clothes to buy and wear, and what to have for lunch. The daughter states that she needs someone to direct her and reassure her when she gets anxious. With which personality disorder is this presentation most consistent?

  • A. Histrionic
  • B. Dependent
  • C. Narcissistic
  • D. Borderline
Correct Answer: B

Rationale: The correct answer is B: Dependent. This presentation is most consistent with dependent personality disorder because the daughter is displaying excessive need for someone to take care of her and make decisions for her, as well as seeking reassurance and guidance when anxious. Individuals with dependent personality disorder often lack self-confidence and rely heavily on others for emotional and physical needs.

Choice A: Histrionic personality disorder is characterized by attention-seeking behavior and excessive emotions, which do not match the daughter's presentation.

Choice C: Narcissistic personality disorder involves a grandiose sense of self-importance and a lack of empathy for others, which is not evident in the daughter's behavior.

Choice D: Borderline personality disorder is characterized by unstable relationships, self-image, and emotions, as well as impulsive behaviors, which are not reflected in the daughter's need for constant direction and reassurance.

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A patient tells a nurse, 'The others won't give me my pain meds early, but you are more understanding, you know what it's like to be in pain, and you don't want to see your patients suffer. Could you find a way to get me my pill now? I won't tell anyone.' Which response by the nurse would be most therapeutic?

  • A. I'm not comfortable doing that,' then ignore subsequent requests for early meds.
  • B. I'll have to check with your doctor about that; I will get back to you after I do.'
  • C. It would be unsafe to give the medicine early; none of us will do that.'
  • D. I understand that you have pain, but giving medicine too soon would not be safe.'
Correct Answer: D

Rationale: Step 1: Acknowledge the patient's pain and show understanding.
Step 2: Emphasize the importance of safety in medication administration.
Step 3: Set clear boundaries by explaining why giving medicine too soon is unsafe.
Step 4: Reiterate empathy for the patient's pain while prioritizing safety.
Summary: Answer D is correct as it acknowledges the patient's pain, emphasizes safety, sets clear boundaries, and maintains empathy. Other choices either ignore the patient's request, defer responsibility, or solely focus on safety without empathy.

In DSM-IV-TR intellectual disabilities are divided into a number of degrees of severity, depending primarily on the range of IQ score provided by the sufferer. One of these is Mild Mental Retardation, corresponding to an IQ score between:

  • A. 60-65 to 80
  • B. 40-55 to 60
  • C. 50-55 to 70
  • D. 70-75 to 90
Correct Answer: C

Rationale: Mild Mental Retardation: Defined by DSM-IV-TR as an IQ score between 50-55 to 70.

A patient with bipolar disorder is hyperactive and has not slept for 3 days. Mood and behavior are labile. The patient threatens to hit another patient. Which response by the nurse is appropriate?

  • A. Stop that now. No one did anything to provoke an attack by you.
  • B. If you try that again, you will be placed in seclusion immediately.
  • C. Do not hit anyone. If you are unable to control yourself, we will help you.
  • D. You know we will not let you hit anyone. Why do you continue this behavior?
Correct Answer: C

Rationale: The correct answer is C because it acknowledges the patient's struggle to control their behavior and offers support. It emphasizes the importance of not hitting anyone while also reassuring the patient that help is available if needed. This response promotes a therapeutic environment by setting clear boundaries and offering assistance rather than using threats or aggression.

Choice A is incorrect as it may escalate the situation by using a confrontational tone, potentially provoking further aggression. Choice B is also incorrect as it threatens the patient with seclusion, which can be seen as punitive and may not address the underlying issues causing the behavior. Choice D is incorrect as it does not provide a clear directive to prevent violence and instead questions the patient's behavior without offering immediate support.

Which outcome is realistic for a client with stage 1 Alzheimer's disease?

  • A. Appropriate long-term placement will be arranged to maintain caregiver's health and well-being.
  • B. The client will maintain the highest possible functional level within his or her capacity.
  • C. All day-to-day decisions will be made by the caregiver to relieve client of stress.
  • D. The client will remain fully functional physically, since Alzheimer's affects only the brain.
Correct Answer: B

Rationale: The correct answer is B because in stage 1 Alzheimer's, individuals can still maintain a relatively high level of functionality. This is because in the early stages, the cognitive decline is mild and individuals can still perform daily tasks independently. It is important to focus on maximizing the client's functional abilities through cognitive exercises and support services.

Choice A is incorrect because long-term placement may not be necessary in stage 1 and should only be considered if the caregiver's health is at risk. Choice C is incorrect because individuals with Alzheimer's should be encouraged to make decisions to maintain their sense of autonomy. Choice D is incorrect because Alzheimer's is a progressive disease that affects both cognitive and physical functions over time.

What is not the primary evidence-based approach to managing oppositional behaviour in children?

  • A. Cognitive-behavioural intervention
  • B. Psychosocial intervention
  • C. Pharmacological intervention
  • D. Family therapy
Correct Answer: C

Rationale: Pharmacological intervention is not a primary approach for oppositional behavior; psychosocial interventions like parent training are first-line.

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