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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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A nurse is caring for a patient with bulimia nervosa. What should the nurse do to promote a healthy eating pattern?
- A. Provide a strict, rigid eating schedule without flexibility.
- B. Allow the patient to choose meals without any guidelines.
- C. Encourage regular meals and snacks with a focus on nutrition.
- D. Promote food restriction to avoid feelings of guilt after eating.
Correct Answer: C
Rationale: The correct answer is C because encouraging regular meals and snacks with a focus on nutrition helps stabilize blood sugar levels, reduce binge eating episodes, and promote overall health. This approach also supports the patient in developing a balanced relationship with food.
A: Providing a strict, rigid eating schedule may increase anxiety and reinforce unhealthy behaviors.
B: Allowing the patient to choose meals without guidelines may lead to erratic eating patterns and poor nutrition.
D: Promoting food restriction can exacerbate feelings of guilt and perpetuate the cycle of binge eating.
A new nurse asks the experienced nurse who is caring for a battered woman client, 'Why did you ask about culture when it was obvious you needed to focus on the battering?' The experienced nurse should respond:
- A. It's just a habit I got into a while ago.'
- B. It helps me focus on whether to do a complete physical assessment.'
- C. Culture is a determinant of how women interpret and respond to violence.'
- D. If I know more about her I can refer her to a shelter that caters to her ethnic group.'
Correct Answer: C
Rationale: Rationale:
- Choice C is correct because culture influences how individuals perceive and respond to violence, impacting their help-seeking behaviors and coping mechanisms.
- Understanding the client's cultural background is crucial for providing appropriate care and support.
- Choices A, B, and D are incorrect as they do not address the importance of considering culture in understanding and addressing domestic violence in this context.
A nurse assessing an elderly patient for depression and suicide potential should include questions about mood as well as: (Select one tha does not apply)
- A. anhedonia.
- B. increased appetite.
- C. sleep pattern changes.
- D. increased concerns with bodily functions.
Correct Answer: B
Rationale: The correct responses (A, C, E) relate to symptoms often noted in elderly patients with depression: anhedonia (loss of pleasure), sleep changes, and somatic concerns. Increased appetite (B) is less typical than anorexia, and grandiosity (D) relates to bipolar disorder, not depression.
Which nursing progress note would most suggest that the treatment plan of a severely depressed and withdrawn patient has been effective?
- A. Slept 6 hours straight, sang with activity group, eager to see grandchild.
- B. Slept 8 hours, attended craft group, ate half of lunch, denies suicidal ideation.
- C. Slept 10 hours, personal hygiene adequate with assistance, lost one pound.
- D. Slept 7 hours on and off, reports "food has no taste", no self-harm noted.
Correct Answer: A
Rationale: The correct answer is A because it indicates positive changes in mood, engagement, and social interaction, which are key indicators of effective treatment for severe depression. Sleeping 6 hours straight shows improved sleep patterns, singing with the activity group reflects increased participation and enjoyment, and being eager to see the grandchild demonstrates a renewed sense of joy and connection.
Choice B is incorrect because although the patient denies suicidal ideation, the level of activity and engagement is not as high as in choice A. Choice C is incorrect as the focus is on physical aspects rather than emotional well-being and social interaction. Choice D is incorrect because the patient still shows signs of depression such as lack of appetite and loss of interest in activities.
A patient diagnosed with a serious mental illness lives independently and attends a psychosocial rehabilitation program. The patient presents at the emergency department seeking hospitalization. The patient has no acute symptoms but says, 'I have no money to pay my rent or refill my prescription.' Select the nurses best action.
- A. Involve the patients case manager to provide crisis intervention
- B. Send the patient to a homeless shelter until housing can be arranged
- C. Arrange for a short in-patient admission and begin discharge planning
- D. Explain that one must have active psychiatric symptoms to be admitted
Correct Answer: A
Rationale: Impaired stress tolerance and problem-solving abilities can cause persons with SMI to experience relatively minor stressors as crises. This patient has run out of money, and this has overwhelmed her ability to cope, resulting in a crisis for which crisis intervention would be an appropriate response. Inpatient care is not clinically indicated nor is the patient homeless (although she may fear she is). Telling the patient that she is not symptomatic enough to be admitted may prompt malingering.