Nokea
What is the main issue for adolescents with anorexia?
- A. Anxiety.
- B. Control.
- C. Body image.
- D. Appropriate behavior.
Correct Answer: B
Rationale: The correct answer is B: Control. Adolescents with anorexia often have a strong desire for control over their lives, including their body and food intake. This need for control can manifest in restrictive eating behaviors. Anxiety (choice A) may be a symptom but is not the main issue. Body image (choice C) is a contributing factor, but not the primary issue. Appropriate behavior (choice D) is too broad and not specific to the core issue of control seen in anorexia.
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The client tells the nurse, 'I thought my psychiatrist was the best doctor in the world. I thought he understood me completely. Now, I hate him! He doesn't understand me at all. He's just dumping me to go on a 2-week vacation.' The nurse assesses the client's description of feelings about the physician as evidence of the use of:
- A. Splitting
- B. Projective identification
- C. Isolation of affect
- D. Dissociation
Correct Answer: A
Rationale: The correct answer is A: Splitting. Splitting is a defense mechanism where a person sees things in extremes of either all good or all bad. In this scenario, the client initially idealizes the psychiatrist as the best doctor, then suddenly devalues and hates him for taking a vacation, indicating a shift from all good to all bad. This extreme change in perception is characteristic of splitting.
B: Projective identification involves projecting one's own feelings onto another person and then identifying with those projected feelings. This choice does not fit the scenario as the client is not projecting their feelings onto the psychiatrist.
C: Isolation of affect refers to the separation of feelings from ideas and events. The client's strong emotions towards the psychiatrist do not demonstrate a lack of emotional expression or detachment from feelings.
D: Dissociation is a defense mechanism where thoughts, feelings, and experiences are separated from conscious awareness. The client's reaction does not suggest a disconnection from reality or consciousness.
A depressed patient tells the nurse, "The bad things that happen are always my fault." How should the nurse respond to assist the patient to reframe this overgeneralization?
- A. I really doubt that one person can be blamed for all the bad things that happen.
- B. You are being exceptionally hard on yourself when you imply you are a jinx.
- C. What about the good things that happen; are any of those ever your fault?
- D. Let's look at one bad thing that happened to see if another explanation exists.
Correct Answer: D
Rationale: The correct answer is D because it encourages the patient to challenge the overgeneralization by exploring alternative explanations for a specific event. By examining one bad thing in detail, the patient can see that not everything is their fault, promoting a more balanced perspective.
A is incorrect because it simply doubts the patient's statement without providing a constructive way to reframe it. B is incorrect as it introduces the idea of being a jinx, which may further reinforce the patient's negative self-perception. C is incorrect as it diverts the focus to good things, which does not address the patient's negative beliefs about themselves.
Which of these nursing communications best reflects the nurse's use of an empowerment model with an individual who has been abused?
- A. Let me share with you my knowledge of what happens psychologically to individuals who have been abused.'
- B. I know you feel that your partner will change, but the current research does not validate your thinking.'
- C. It's up to you to end the violence. You are the only one who can set limits on how your partner is allowed to treat you.'
- D. Let's consider what you believe your options are in terms of your relationship with your partner in light of the behavior toward you.'
Correct Answer: D
Rationale: The correct answer, D, reflects the nurse's use of an empowerment model because it focuses on exploring the individual's beliefs and options, empowering them to make informed decisions. The nurse is not imposing their own knowledge or opinions but instead facilitating the individual's self-reflection and decision-making process. This approach respects the individual's autonomy and promotes empowerment by helping them identify and evaluate their own choices.
Choice A focuses on the nurse sharing knowledge, which may come across as patronizing and disempowering. Choice B dismisses the individual's feelings and relies on research rather than empowering the individual to make their own decisions. Choice C places the responsibility solely on the individual to end the violence, which may feel overwhelming and lacking in support or guidance.
Many persons brought before a criminal court have mental illness, have committed minor offenses, and are off medications. The judge consults the nurse at the local community mental health center for guidance about how to respond when handling such cases. Which advice from the nurse would be most appropriate?
- A. Sometimes a little time in jail makes a person rethink what theyve been doing and puts them back on the right track.'
- B. Sentencing such persons to participate in treatment instead of incarcerating them has been shown to reduce repeat offenses.'
- C. Arresting these people helps them in the long run. Sometimes we cannot hospitalize them, but in jail they will get their medication.'
- D. Research suggests that special mental health courts do not make much difference so far, but outpatient commitment does seem to help.'
Correct Answer: B
Rationale: Research supports the use of special mental health courts that can sentence mentally ill persons to treatment instead of jail. Jail exposes vulnerable mentally ill persons to criminals, victimization, and high levels of stimulation and stress. Incarceration can also interrupt eligibility for benefits or lead to the loss of housing and often provides lower-quality mental health treatment in other settings. Recidivism rates for both mentally ill and non-mentally ill offenders are relatively high, so it does not appear that incarceration necessarily leads people to behave more appropriately. In addition, a criminal record can leave them more desperate and with fewer options after release. Research indicates that outpatient commitment is less effective at improving the mental health of mentally ill persons than was expected.
When analyzing the behaviors of a 23-year-old who meets the criteria for antisocial personality disorder, the nurse recognizes that the following nursing diagnosis would be pertinent to his care:
- A. Risk for self-mutilation
- B. Disturbed personal identity
- C. Impaired social interaction
- D. Social isolation
Correct Answer: C
Rationale: Step-by-step rationale for choice C (Impaired social interaction) being the correct answer:
1. Antisocial personality disorder is characterized by a lack of regard for others and a pattern of violating their rights.
2. Individuals with this disorder often have difficulty forming and maintaining healthy relationships.
3. Impaired social interaction reflects the challenges the individual faces in relating to others.
4. This nursing diagnosis would address the core issue of social dysfunction in individuals with antisocial personality disorder.
Summary of why the other choices are incorrect:
A. Risk for self-mutilation - Not typically associated with antisocial personality disorder, more common in other mental health conditions.
B. Disturbed personal identity - Not a primary concern in antisocial personality disorder, which is more about behavior than identity.
D. Social isolation - While individuals with antisocial personality disorder may isolate themselves, impaired social interaction is a more direct and specific issue to address in their care.