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What is the most appropriate nursing goal for a patient with bulimia nervosa?
- A. To eliminate binge-purge episodes and restore healthy eating habits.
- B. To focus on weight loss and body image issues.
- C. To monitor calorie intake and restrict food consumption.
- D. To encourage excessive exercise to maintain weight control.
Correct Answer: A
Rationale: The correct answer is A: To eliminate binge-purge episodes and restore healthy eating habits. This goal is appropriate as it addresses the core issue of bulimia nervosa, which is the cycle of bingeing and purging. By focusing on eliminating these episodes and promoting healthy eating habits, the patient can achieve long-term recovery.
Choices B, C, and D are incorrect because they do not address the underlying psychological and behavioral aspects of bulimia nervosa. Weight loss and body image issues (B) may exacerbate the disorder, monitoring calorie intake and restricting food consumption (C) can reinforce the cycle of bingeing and purging, and encouraging excessive exercise (D) can lead to further health complications.
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A group of teenagers are discussing their individual problems associated with having an eating disorder. Which findings would the nurse attribute to purging?
- A. Excessive facial hair
- B. Elevated blood pressure
- C. Polyuria
- D. Dental enamel erosion
Correct Answer: C
Rationale: Rationale for Correct Answer (C - Polyuria):
1. Purging involves self-induced vomiting or misuse of laxatives/diuretics.
2. Vomiting can lead to electrolyte imbalances, causing increased urine production (polyuria).
3. Polyuria is a common sign of purging behaviors due to electrolyte disturbances.
Summary of Incorrect Choices:
A: Excessive facial hair - Not directly related to purging behavior.
B: Elevated blood pressure - Could be related to stress or other factors, not specific to purging.
D: Dental enamel erosion - More likely associated with frequent vomiting (purging) rather than polyuria.
A 65-year-old woman has a two-year history of mucous diarrhoea due to a large villous adenoma of the rectum. She is also taking digoxin and diuretics for chronic congestive failure. Which of the following investigations would be the most helpful prior to surgery?
- A. Serum chloride.
- B. Serum digoxin.
- C. Serum calcium.
- D. Serum potassium.
Correct Answer: D
Rationale: Villous adenomas cause potassium loss via diarrhea, and diuretics exacerbate this, risking hypokalemia, which is dangerous with digoxin (toxicity risk). Serum potassium (D) is critical pre-surgery.
Which of the following options is not useful for reducing mental conflict?
- A. Stay away from the causes of conflict.
- B. Find out the exact causes of the conflict.
- C. Think about what's left out.
- D. Consult an adult.
Correct Answer: C
Rationale: Mental conflict refers to a state of inner turmoil or struggle that arises when an individual experiences opposing thoughts, desires, or emotions. Strategies useful for reducing mental conflict include avoiding triggers (A), understanding root causes (B), and seeking support (D). Thinking about what's left out (C) can lead to overthinking, increasing conflict rather than reducing it.
An 82-year-old widow with Alzheimer's disease lives with her daughter's family, which owns a catering business. During the week, the patient attends a day care center for patients with dementia. During the evenings, members of the family care for the patient. One day, the nurse at the day care center notices the patient's appearance is disheveled and that she startles easily. She has a strong odor of urine, and her hair is uncombed. When the nurse escorts the patient to the bathroom, she notices bruises on her wrists and back. What most likely explains the nurse's observations?
- A. The patient is being neglected and abused within the family.
- B. The dementia is progressing, reducing self-care and increasing falls.
- C. The patient is being inadequately cared for, resulting in accidents.
- D. The patient has developed delirium, resulting in poor hygiene and injuries.
Correct Answer: A
Rationale: The correct answer is A: The patient is being neglected and abused within the family. The nurse's observations of the patient's disheveled appearance, strong odor of urine, uncombed hair, and bruises indicate signs of neglect and abuse. Here's the rationale:
1. Disheveled appearance and strong odor of urine suggest lack of personal care.
2. Uncombed hair signals neglect in grooming.
3. Bruises on wrists and back are indicative of physical abuse.
4. Startling easily may be due to fear or anxiety from abuse.
In summary, the other choices (B, C, D) are incorrect because they do not account for the combination of neglect, poor hygiene, and physical injuries seen in the patient, which are more indicative of abuse and neglect within the family.
A nurse would conclude that a patient with an eating disorder is exhibiting a cognitive distortion after hearing the patient make which statement?
- A. I see now that I need to establish my own preferences and routines.'
- B. Bingeing makes my feelings of both isolation and loneliness go away.'
- C. Controlling what I eat has been a way for me to exert control over my life.'
- D. I need to watch for hunger and fatigue as triggers for my eating disorder.'
Correct Answer: B
Rationale: The correct answer is B because the statement reflects emotional reasoning, a common cognitive distortion in eating disorders. The patient believes that bingeing is an effective way to cope with feelings of isolation and loneliness, which is not a healthy or rational belief. This cognitive distortion can perpetuate the cycle of disordered eating behavior.
A: This choice shows a healthy realization and decision-making process, indicating a positive step towards recovery.
C: While controlling food intake may be a coping mechanism, it doesn't necessarily indicate a cognitive distortion.
D: This choice demonstrates awareness of triggers, which is important for managing the disorder, but it doesn't necessarily indicate a cognitive distortion.