Population Based Care

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What is the priority nursing intervention for a patient with bulimia nervosa who is engaging in purging behaviors?

  • A. Monitor electrolyte levels and cardiac function.
  • B. Encourage self-monitoring of food intake.
  • C. Provide emotional support and promote body image acceptance.
  • D. Focus on encouraging weight loss through diet control.
Correct Answer: A

Rationale: The correct answer is A. The priority nursing intervention for a patient with bulimia nervosa engaging in purging behaviors is to monitor electrolyte levels and cardiac function. This is crucial due to the potential electrolyte imbalances and cardiac complications resulting from purging behaviors. Monitoring these parameters helps prevent life-threatening conditions such as hypokalemia and arrhythmias.

Option B is incorrect as self-monitoring of food intake may not address the immediate health risks associated with purging behaviors. Option C is also incorrect as emotional support and body image acceptance are important but not the immediate priority in this case. Option D is incorrect as focusing on weight loss through diet control can exacerbate the patient's eating disorder behaviors and does not address the urgent medical concerns associated with purging.

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Which theme is most likely during family therapy with parents, siblings, and a teen patient with anorexia nervosa who engages in provocative behavior?

  • A. Stable coalitions between family members
  • B. Interpreting negative messages as positive
  • C. Competition between the patient and father
  • D. Lack of trust in the patient by family members
Correct Answer: C

Rationale: The correct answer is C: Competition between the patient and father. In family therapy with a teen patient with anorexia nervosa, the theme of competition between the patient and a parental figure, often the father, can be prominent. The rationale is that the father's influence and expectations can contribute to the teen's feelings of inadequacy and drive for control through anorexic behaviors. This dynamic can be explored and addressed in therapy to improve family relationships and support the patient's recovery.

A: Stable coalitions between family members - This is less likely as anorexia nervosa often disrupts family dynamics.
B: Interpreting negative messages as positive - While this can be a relevant theme, it is not as central to the specific scenario described.
D: Lack of trust in the patient by family members - While trust issues may exist, the theme of competition is more relevant in this context.

A patient has a maladaptive response to eating regulation. Findings include the following: height, 5 feet 3 inches; current weight, 80 pounds with weight loss of 30% of body weight over the past 3 months; T, 96.6m F; BP, 68/40; P, 40; R, 20; poor skin turgor; lanugo; amenorrhea of 6 months' duration; admits to restricting intake to 350 calories daily; is a vegetarian; dissatisfied with eating pattern as evidenced by patient statement, 'I need to lose another 10 pounds to be at ideal weight'; diagnostic testing reveals serum potassium of 2.9 mEq/L and urine specific gravity of 1.028. Which of the following would be the highest priority nursing diagnosis for this patient?

  • A. Imbalanced nutrition, less than body requirements.
  • B. Disturbed body image.
  • C. Deficient fluid volume.
  • D. Powerlessness.
Correct Answer: C

Rationale: The correct answer is C: Deficient fluid volume. The patient is displaying signs of severe malnutrition and dehydration, as evidenced by significant weight loss, low blood pressure, low heart rate, and poor skin turgor. The low serum potassium and high urine specific gravity indicate dehydration. Addressing fluid volume deficiency is the top priority to stabilize the patient's condition and prevent further complications like electrolyte imbalances and organ damage. Choices A and B are important but secondary to addressing the immediate threat of dehydration. Choice D is not the priority as the patient's primary concern is physiological rather than psychological.

Many individuals with intellectual disabilities are conscientious and valued workers employed in which of the normal work environments. Individuals with more specific needs may need to pursue employment within:

  • A. Sheltered accommodation
  • B. Special workshops
  • C. Sheltered workshops
  • D. Special accommodation
Correct Answer: C

Rationale: Sheltered Workshops: Employment settings tailored to the needs and abilities of individuals with intellectual disabilities.

The distinction between obsessions and compulsions is the distinction between

  • A. engaging in behaviors that are merely inconvenient and those that are severely disruptive
  • B. having positive and negative feelings toward an object or event
  • C. thoughts that are evidence of neurosis or those that are evidence of psychosis
  • D. having repetitious thoughts or engaging in repetitious actions
Correct Answer: D

Rationale: Obsessions are intrusive thoughts, while compulsions are repetitive actions to relieve them.

The highest priority for assessment by nurses caring for older adults who self-administer medications is:

  • A. use of multiple drugs with anticholinergic effects.
  • B. overuse of medications for erectile dysfunction.
  • C. missed doses of medications for arthritis.
  • D. trading medications with acquaintances.
Correct Answer: A

Rationale: Anticholinergic effects are cumulative in older adults and often have adverse consequences related to accidents and injuries (A), making it the highest priority. The other issues (B, C, D) may be relevant but are less critical.

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