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When a patient with anorexia nervosa is admitted for treatment, the milieu should provide: (Select all that apply.)
- A. Flexible mealtimes.
- B. Unscheduled weight checks.
- C. Adherence to a selected menu.
- D. None of the above.
Correct Answer: A
Rationale: The correct answer is A: Flexible mealtimes. In the treatment of anorexia nervosa, providing flexible mealtimes allows patients to regain a sense of control over their eating habits, which is crucial in their recovery process. This approach helps to reduce anxiety around food and promotes a healthier relationship with eating.
Choice B: Unscheduled weight checks can be triggering and anxiety-provoking for patients with anorexia nervosa, as weight monitoring can be a significant source of distress for them.
Choice C: Adherence to a selected menu may reinforce rigid eating patterns and control issues related to food, which can be counterproductive in the treatment of anorexia nervosa.
Choice D: None of the above is incorrect because providing flexible mealtimes is essential in creating a supportive and therapeutic environment for patients with anorexia nervosa.
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A patient reports an intense, overwhelming fear of driving a car. The fear has disrupted all elements of the patient's life. The patient does not go to the grocery store unless driven by someone else, has relinquished their job, and has few social contacts. The patient's treatment plan includes:
- A. assertiveness training
- B. biofeedback
- C. stress management assistance
- D. systematic desensitization
Correct Answer: D
Rationale: Systematic desensitization gradually exposes the patient to driving-related stimuli, reducing phobia through controlled steps.
What is the correct assessment for a patient with bulimia nervosa who frequently engages in purging behaviors?
- A. Observe for parotid gland enlargement and dehydration.
- B. Assess for fluid retention and leg swelling.
- C. Perform regular weight checks to assess for weight loss.
- D. Evaluate for signs of hyperactivity and poor sleep.
Correct Answer: A
Rationale: The correct assessment for a patient with bulimia nervosa who frequently engages in purging behaviors is to observe for parotid gland enlargement and dehydration. Parotid gland enlargement is a common physical manifestation due to repeated vomiting, and dehydration can result from purging behaviors. This assessment is crucial in monitoring the patient's physical health and identifying potential complications. Assessing for fluid retention and leg swelling (Choice B) is more typical in conditions like heart failure. Performing weight checks (Choice C) may not accurately reflect the patient's health status due to fluid shifts. Evaluating for signs of hyperactivity and poor sleep (Choice D) are not directly related to the immediate physical consequences of purging behaviors.
A worker is characterized by her co-workers as 'painfully shy' and lacking in self-confidence. Her co-workers say she stays in her cubicle all day, never coming out for breaks or lunch. One day after falling on the ice in the parking lot, she goes to the nurse's office, where she apologizes for falling and mentions that she hopes the company will not fire her for being so clumsy. With which diagnosis is this presentation most consistent?
- A. Avoidant
- B. Dependent
- C. Histrionic
- D. Paranoid
Correct Answer: A
Rationale: The correct answer is A: Avoidant. This diagnosis is consistent because the worker exhibits characteristics of extreme shyness, lack of self-confidence, social avoidance, and fear of rejection or criticism. By apologizing excessively for a simple accident and expressing worry about being fired for it, the worker's behavior aligns with the avoidance of social situations and excessive concern about negative evaluation typical of Avoidant Personality Disorder.
Choice B: Dependent, does not fit as the worker is not displaying excessive need for others to take responsibility for major areas of her life.
Choice C: Histrionic, is not a match as this disorder is characterized by attention-seeking behavior, which is not evident in the worker's presentation.
Choice D: Paranoid, is not the correct diagnosis as the worker does not display distrust or suspiciousness towards others.
In planning aftercare for a client with schizophrenia and whose insurance benefits have been exhausted, the nurse who is concerned about overcoming negative symptoms will make provisions for the client to have stimulation, structure, socialization, and support. Which option would best incorporate these factors?
- A. Day hospitalization
- B. Attending a psychosocial club
- C. Living with his elderly mother
- D. Spending free time in the mall
Correct Answer: B
Rationale: The correct answer is B, attending a psychosocial club. This option best incorporates the factors of stimulation, structure, socialization, and support. Psychosocial clubs offer a structured environment with various activities to stimulate the client's mind and prevent social isolation. It provides opportunities for socialization and peer support, which are crucial for individuals with schizophrenia. Day hospitalization may offer structure but lacks the socialization aspect. Living with his elderly mother may provide support but not necessarily the stimulation and structure needed. Spending free time in the mall does not provide the structured environment, socialization, or support necessary for aftercare in schizophrenia.
A young, newly married adult says, 'My spouse never lets me out of sight. I'm not allowed to do anything on my own, and I'm constantly accused of cheating.' Which nursing communication is most therapeutic for this patient?
- A. Have you discussed the behavior with your spouse?'
- B. How does your spouse's behavior make you feel?'
- C. Are there other examples of controlling behaviors on your spouse's part?'
- D. Do you feel that your spouse has anything to be upset or suspicious about?'
Correct Answer: B
Rationale: The correct answer is B: "How does your spouse's behavior make you feel?" This question focuses on the patient's emotions, allowing them to express their feelings and validating their experiences. It shows empathy and encourages the patient to explore and understand their own emotional responses to the situation.
Choice A focuses on addressing the behavior directly without acknowledging the patient's emotions. Choice C asks for more examples of controlling behavior, which may feel judgmental. Choice D suggests that the spouse's behavior is justified, which can further invalidate the patient's feelings. Overall, choice B is the most therapeutic as it promotes emotional exploration and support.