Nokea
The Omnibus Budget Reconciliation Act (OBRA) provides standards of care for which of the following:
- A. Very young
- B. Older adults
- C. Those who have certain intellectual communication difficulties
- D. Those without medical insurance
Correct Answer: B
Rationale: OBRA provides regulations for proper assessment of the elderly (B); for this reason, registered nurses have to provide the initial physical assessment.
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Schizophrenia is usually diagnosed in:
- A. Infancy
- B. Childhood
- C. Early adulthood
- D. Old age
Correct Answer: C
Rationale: Schizophrenia typically emerges in early adulthood (late teens to early 20s), though symptoms may appear earlier or later in rare cases.
Care planning requires that a nurse recognize that the dynamic focus directing a patient with anorexia nervosa is:
- A. managing weight gain.
- B. controlling personal stressors.
- C. maintaining a sense of control.
- D. avoiding social interactions.
Correct Answer: C
Rationale: Step 1: Anorexia nervosa is characterized by an intense fear of gaining weight and a distorted body image.
Step 2: Patients often use strict control over food intake as a way to cope with underlying emotional issues.
Step 3: Maintaining a sense of control is crucial in managing anorexia nervosa as it addresses the core psychological aspects driving the disorder.
Step 4: Managing weight gain (A) is not the primary focus as patients may resist gaining weight due to their fear.
Step 5: Controlling personal stressors (B) may be important but does not address the underlying issue of control related to food and body.
Step 6: Avoiding social interactions (D) does not address the core psychological need for control and can further isolate the patient.
A woman who is a victim of severe emotional violence tells the nurse that her husband abuses her most often when he is intoxicated, just as his father had beaten him and his mother. The woman is aware of the location of a safe house and has considered leaving home with her two children, but she cites being brought up to believe 'you keep quiet and stay together, no matter what happens.' She states the husband is always apologetic and remorseful after an incident. The nurse responds, 'You cannot live like this; you have to defend yourself and your children.' Which statement most accurately describes the nurse's response?
- A. It is an honest and direct response that will help build trust and rapport.
- B. It suggests that the nurse herself has been a victim of physical abuse.
- C. It is unprofessional, but it will likely help by motivating the patient.
- D. It is a human but unprofessional response and is not helpful.
Correct Answer: D
Rationale: The correct answer is D because the nurse's response is not helpful. Here's a step-by-step rationale:
1. The nurse's response is human because she empathizes with the woman's situation.
2. However, the response is unprofessional as it is too directive and lacks a proper assessment or exploration of the woman's feelings and options.
3. Telling the woman to defend herself may put her at further risk and does not address the underlying issues of abuse and trauma.
4. The response fails to consider the complexities of the woman's situation, such as her cultural beliefs and the cycle of violence she is caught in.
5. Instead, a professional response would involve a more holistic approach, including safety planning, providing resources, and offering support without judgment or pressure.
A widow, aged 72 years, lives alone and is visited weekly by her son. She takes digoxin, hydrochlorothiazide, and an antihypertensive drug. She also has a prescription for diazepam (Valium) as needed for moderate to severe anxiety. When the son visited today, he found his mother confused and disoriented, with an unsteady gait. The nurse assessed the patient as having several cognitive problems, including memory and attention deficits and fluctuating levels of orientation. The nurse confirms that the patient's symptoms developed:
- A. Over the past few days.
- B. Over the past few weeks.
- C. Over the past few months.
- D. None of the above.
Correct Answer: A
Rationale: The correct answer is A: Over the past few days. The sudden onset of confusion, disorientation, and cognitive deficits in the elderly patient suggests an acute change in her condition. This acute change is more indicative of a recent event or medication-related issue rather than a gradual decline over weeks or months. The sudden onset could be due to factors such as medication interactions, overdose, or underlying medical conditions. It is crucial to investigate recent changes in medications, lab results, or any other potential triggers that might have led to this acute cognitive decline. Choices B, C, and D are incorrect because they imply a gradual decline over weeks, months, or no specific timeframe, which does not align with the sudden onset observed in the patient.
A 5-year-old presents with a history of urgency of micturition, occasional enuresis, and a slight, non-offensive vaginal discharge for 3 months. She has had no vaginal bleeding. Examination reveals some reddening of the labia majora. Which one of the following is the most likely diagnosis?
- A. Trichomonal infection.
- B. Gonorrhoea.
- C. Cystitis.
- D. Non-specific vulvo-vaginitis.
Correct Answer: D
Rationale: Non-specific vulvo-vaginitis (E) is common in young girls due to hygiene or irritation, causing these symptoms. Trichomonas (A) and gonorrhoea (B) are rare without sexual history, cystitis (C) lacks vaginal signs, and foreign body (D) typically causes bleeding or foul discharge.