Nokea
To plan effective interventions, the nurse should understand that the underlying reason a patient with paranoid personality disorder is so critical of others probably lies in the patient's:
- A. need to control all aspects of the world around him.
- B. use of intellectualization to protect against anxiety.
- C. inflexible view of the environment and the people in it.
- D. projection of blame for his own shortcomings onto others.
Correct Answer: D
Rationale: The correct answer is D because paranoid personality disorder is characterized by distrust and suspicion of others, leading individuals to project their own negative traits onto others (projection). This defense mechanism helps them avoid accepting their own shortcomings. Option A is incorrect because the focus is on control, not blame. Option B is incorrect as intellectualization is a defense mechanism that involves avoiding emotions by focusing on rational aspects. Option C is incorrect as it refers to rigidity and not projection of blame. In summary, projection of blame onto others is the underlying reason for the critical behavior in paranoid personality disorder.
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The nurse reports to the interdisciplinary team that an antisocial patient lies to other patients, verbally abuses a patient with Alzheimer's disease, flatters his primary nurse, and is detached and superficial during counseling sessions. Which behavior should be the priority focus of limit setting?
- A. Lying to other patients
- B. Flattering the nursing staff
- C. Verbally abusing other patients
- D. Superficiality during counseling
Correct Answer: C
Rationale: The priority focus of limit setting should be on verbally abusing other patients (Choice C) because it directly harms others and creates a hostile environment. This behavior is not only detrimental to the well-being of other patients but also disrupts the therapeutic milieu. Limiting this behavior is crucial to ensure the safety and emotional health of all patients in the care setting. Lying to other patients (Choice A), flattering the nursing staff (Choice B), and being superficial during counseling sessions (Choice D) are concerning behaviors as well, but they do not pose an immediate risk to the safety and well-being of others in the same way that verbal abuse does. It is important to address all inappropriate behaviors, but the priority should be given to the behavior that has the most significant negative impact on the therapeutic environment.
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. Develop strategies to ensure the client's safety.
- B. Seek respite care to get a break.
- C. Join a support group for caregivers.
- D. None of the above.
Correct Answer: A
Rationale: The correct answer is A: Develop strategies to ensure the client's safety. This is the most appropriate outcome as it directly addresses the caregiver's concerns of the client wandering and ensures their safety. By developing strategies such as installing door alarms, creating a safe sleeping environment, and establishing a routine, the caregiver can mitigate the risks associated with wandering behavior.
Summary:
- B: Seek respite care to get a break: While respite care is important for caregiver well-being, it does not directly address the safety concerns of the client wandering.
- C: Join a support group for caregivers: While support groups can be beneficial for emotional support, they may not provide immediate solutions to ensure the client's safety.
When a victim of sexual assault is discharged from the emergency department, the nurse should:
- A. Notify the patient's family of the event to ensure support for the patient.
- B. Offer to stay with the patient until stability is regained.
- C. Advise the patient to try not to think about the assault.
- D. Provide referral information verbally and in writing.
Correct Answer: D
Rationale: The correct answer is D because providing referral information verbally and in writing ensures that the victim has access to appropriate resources for follow-up care and support. This step is crucial in helping the victim navigate the emotional and physical aftermath of the assault.
A: Notifying the patient's family without the patient's consent could violate the patient's privacy and autonomy.
B: While offering to stay with the patient shows support, it may not always be feasible and may not address the victim's long-term needs.
C: Advising the patient to try not to think about the assault is dismissive of their trauma and does not provide constructive support.
An elderly woman is brought to the clinic by her daughter. The client states that she has had a cold for several days. Her daughter states that her mother has been confused about when her routine medications are to be taken and that her mother has never experienced confusion about her medications before. Based on this information, it is important that the nurse ask the client whether:
- A. There is a history of mental illness in the family
- B. She has been given a diagnosis of a mental health disorder in the past
- C. She can recall her last visit to a physician
- D. She has taken any over-the-counter medications for her cold
Correct Answer: D
Rationale: The correct answer is D: She has taken any over-the-counter medications for her cold. It is important for the nurse to ask this question because over-the-counter medications can sometimes interact with prescription medications, leading to confusion or other cognitive issues in elderly patients. By identifying any OTC medications the client has taken, the nurse can assess potential drug interactions that may be contributing to the confusion.
Choices A, B, and C are incorrect. History of mental illness in the family or a previous diagnosis of mental health disorder may not directly address the current issue of confusion related to medication management. Asking about the last visit to a physician is also less relevant compared to inquiring about current medication use for a potential cause of confusion.
Which of the following combines the best treatments for postpartum blues?
- A. Antidepressants, sleep, crisis intervention
- B. Rest, support, compassion
- C. Mother-baby bonding session, family education, antidepressants
- D. Analgesics for post-delivery pain, rest, longer hospital stay
Correct Answer: B
Rationale: Antidepressants have no use in postpartum blues (A, C). Rest, support, and compassion (B) are the main interventions for this self-limiting condition, unlike analgesics or extended hospital stays (D).