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The nurse is assessing a patient with anorexia nervosa. What is the most important physical examination finding to monitor?
- A. Blood pressure and heart rate.
- B. Height and weight changes.
- C. Skin turgor and hydration status.
- D. Respiratory rate and lung function.
Correct Answer: B
Rationale: The correct answer is B: Height and weight changes. In anorexia nervosa, monitoring height and weight changes is crucial as it reflects the patient's nutritional status and overall health. Weight loss and changes in height can indicate severe malnutrition and potential complications. Blood pressure and heart rate (choice A) can be affected by various factors in anorexia nervosa but may not directly reflect the patient's nutritional status. Skin turgor and hydration status (choice C) are important indicators of hydration levels but may not provide a comprehensive assessment of the patient's nutritional status. Respiratory rate and lung function (choice D) are important, but they may not be the most critical physical examination findings to monitor in anorexia nervosa.
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A nurse is working with a patient with anorexia nervosa. What is the priority assessment for this patient?
- A. Height and weight changes.
- B. Food intake and nutritional status.
- C. Mental health status and body image concerns.
- D. Vital signs and cardiovascular function.
Correct Answer: A
Rationale: The correct answer is A: Height and weight changes. In anorexia nervosa, monitoring height and weight is crucial to assess the severity of malnutrition and potential complications. Weight loss is a key indicator of the patient's nutritional status and overall health decline. Height measurement also helps determine growth patterns in younger patients.
Choice B: Food intake and nutritional status, although important, is not the priority as weight changes provide a more direct reflection of the patient's nutritional status.
Choice C: Mental health status and body image concerns are significant in anorexia nervosa, but assessing height and weight takes precedence due to the immediate physical risks associated with severe malnutrition.
Choice D: Vital signs and cardiovascular function are important, but monitoring height and weight is more specific to the nutritional deficiencies seen in anorexia nervosa.
A psychiatric technician remarks to the nurse, 'That client with dependent personality disorder is so clingy! I almost hate to see her coming my way.' The response by the nurse that will be helpful to the technician is:
- A. I think everyone feels that way. It's difficult to have someone clinging.'
- B. Clients with personality disorders have little regard for the rights of others.'
- C. The client fears having to function independently without direction from someone else.'
- D. The client is so preoccupied with perfection and structure that she's afraid to do anything at all.'
Correct Answer: C
Rationale: The correct answer is C: The client fears having to function independently without direction from someone else. This response is helpful because it provides insight into the underlying fear and motivation of the client's behavior. Clients with dependent personality disorder often have an excessive need to be taken care of and fear being alone or making decisions independently. This response acknowledges the client's struggle with autonomy and offers understanding without judgment.
Choice A is incorrect because it normalizes the technician's negative feelings, which does not address the client's needs. Choice B is incorrect because it makes a generalizing and negative statement about clients with personality disorders, which is stigmatizing and unhelpful. Choice D is incorrect because it describes features more commonly associated with obsessive-compulsive personality disorder, not dependent personality disorder.
During an initial patient interview, the psychiatric-mental health nurse begins by asking the patient to describe their:
- A. current situation
- B. feelings about the current situation
- C. personal history
- D. thoughts about the current situation
Correct Answer: A
Rationale: Starting with the current situation provides a concrete entry point to assess the patient's immediate needs and context.
The characteristic in individuals with personality disorders that makes it most necessary for staff to schedule frequent meetings is:
- A. flexibility and unconventional responses to stress.
- B. a desire to achieve emotional intimacy with staff.
- C. a tendency to evoke countertransference and conflict.
- D. an impaired ability to develop trusting relationships.
Correct Answer: C
Rationale: The correct answer is C because individuals with personality disorders often evoke countertransference and conflict in staff due to their challenging behaviors and interpersonal dynamics. This can lead to potential misunderstandings and ineffective treatment if not addressed through frequent meetings. Option A is incorrect as flexibility and unconventional responses to stress are not typically the primary concern necessitating frequent meetings. Option B is incorrect as a desire for emotional intimacy is not necessarily a reason for staff to schedule frequent meetings. Option D is incorrect as an impaired ability to develop trusting relationships might be a symptom of a personality disorder, but it is not the characteristic that most necessitates frequent meetings.
A patient diagnosed with serious mental illness was living successfully in a group home but wanted an apartment. The prospective landlord said, 'People like you have trouble getting along and paying their rent.' The patient and nurse meet for a problem-solving session. Which options should the nurse endorse? Select one tha does not apply.
- A. Coach the patient in ways to control symptoms effectively
- B. Seek out landlords less affected by the stigma associated with mental illness
- C. Threaten the landlord with legal action because of the discriminatory actions
- D. Have the case manager meet with the landlord to provide education about mental illness
Correct Answer: C
Rationale: Managing symptoms so that they are less obvious or socially disruptive can reduce negative reactions and reduce rejection due to stigma. Seeking a more receptive landlord might be the most expeditious route to housing for this patient. Educating the landlord to reduce stigma might make him more receptive and give the case manager an opportunity to address some of his concerns (e.g., the case manager could arrange a payee to assure that the rent is paid each month). However, threatening a lawsuit would increase the landlords defensiveness and would likely be a long and expensive undertaking. Delaying the patients efforts to become more independent is not clinically necessary according to the data noted here; the problem is the landlords bias and response, not the patients illness. It would be unethical to encourage falsification and poor role modeling to do so; further, if falsification is discovered, it could permit the landlord to refuse or cancel her lease.