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When teaching a patient with binge-purge bulimia, the nurse should give priority to information about:
- A. Self-monitoring of daily food and fluid intake.
- B. Establishing the desired daily weight gain.
- C. Symptoms of hypokalemia.
- D. Self-esteem maintenance
Correct Answer: C
Rationale: The correct answer is C: Symptoms of hypokalemia. This is the priority because individuals with binge-purge bulimia often have electrolyte imbalances, including hypokalemia, which can lead to serious cardiac complications. Educating the patient on recognizing symptoms of hypokalemia, such as weakness, fatigue, and irregular heartbeats, is crucial for early intervention.
A: Self-monitoring of daily food and fluid intake is important but not the priority when dealing with potential life-threatening complications like hypokalemia.
B: Establishing the desired daily weight gain is not appropriate for individuals with binge-purge bulimia as the focus should be on addressing the underlying psychological issues rather than weight gain.
D: Self-esteem maintenance is important in the long term but does not take precedence over addressing immediate health risks such as hypokalemia.
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Which nursing progress note would most suggest that the treatment plan of a severely depressed and withdrawn patient has been effective?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 family has noted the following behaviors in one of their elderly parents: periodic indecisiveness, forgetfulness, mild transient confusion, occasional misperception, distractibility, and occasional unclear thinking. Where on the continuum of cognitive responses would this patient be?
- A. At point 1
- B. At point 2
- C. At point 3
- D. There is insufficient information to make a determination.
Correct Answer: B
Rationale: The correct answer is B: At point 2. This patient's symptoms indicate mild cognitive impairment, which falls between normal age-related decline (point 1) and dementia (point 3). Mild cognitive impairment involves noticeable cognitive changes but does not significantly interfere with daily functioning. Point 1 is too mild for the symptoms described, and point 3 is too severe as the patient's symptoms are not indicative of full-blown dementia. Therefore, the patient is best placed at point 2 on the continuum of cognitive responses.
Which therapy is shown through evidence to be the most effective for a patient with an eating disorder?
- A. Supportive therapy.
- B. Behavioral therapy.
- C. Cognitive behavioral therapy.
- D. Psychoanalytical group therapy.
Correct Answer: C
Rationale: The correct answer is C: Cognitive behavioral therapy (CBT). CBT is the most effective therapy for eating disorders based on research evidence. It helps patients identify and change negative thoughts and behaviors related to food and body image. CBT also teaches coping skills and strategies to manage triggers. Supportive therapy (choice A) offers emotional support but may not target the underlying issues. Behavioral therapy (choice B) focuses on changing specific behaviors but may not address cognitive patterns. Psychoanalytical group therapy (choice D) delves into past experiences but is not as effective as CBT in treating eating disorders.
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: The correct answer is A: use of multiple drugs with anticholinergic effects. This is the highest priority because anticholinergic medications are commonly prescribed to older adults and can lead to serious adverse effects such as confusion, memory issues, and falls. Nurses must assess for these effects to prevent harm.
Choice B (overuse of medications for erectile dysfunction) is not as high a priority as anticholinergic effects, as it is not as common and typically has less immediate serious consequences for older adults.
Choice C (missed doses of medications for arthritis) is important but not as critical as assessing for anticholinergic effects, as missed doses can generally be managed through education and adherence support.
Choice D (trading medications with acquaintances) is a serious concern but is not as high a priority as assessing for anticholinergic effects, as the immediate risks associated with anticholinergic medications are more severe.
A patient tells a nurse, 'The others won't give me my pain meds early, but you are more understanding, you know what it's like to be in pain, and you don't want to see your patients suffer. Could you find a way to get me my pill now? I won't tell anyone.' Which response by the nurse would be most therapeutic?
- A. I'm not comfortable doing that,' then ignore subsequent requests for early meds.
- B. I'll have to check with your doctor about that; I will get back to you after I do.'
- C. It would be unsafe to give the medicine early; none of us will do that.'
- D. I understand that you have pain, but giving medicine too soon would not be safe.'
Correct Answer: D
Rationale: Rationale:
- Choice D is the correct response because it acknowledges the patient's pain, shows empathy, and educates on the importance of safe medication administration.
- Step 1: Acknowledge the patient's pain to validate their feelings.
- Step 2: Express understanding but emphasize safety concerns to educate the patient on responsible medication use.
- Step 3: Maintain boundaries by emphasizing the importance of safe medication practices.
- Other Choices:
- A: Ignoring the patient's request can create distrust and may not address the underlying issue of pain management.
- B: Delaying the response by involving the doctor may increase the patient's anxiety and does not address the safety concern.
- C: Simply stating that it is unsafe without providing further explanation or addressing the patient's concerns lacks empathy and education.