Which nursing progress note would most suggest that the treatment plan of a severely depressed and withdrawn patient has been effective?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.
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When an individual with multiple cognitive disabilities has extraordinary proficiency in one isolated skill, this is known as?
- A. Rainman syndrome
- B. Asperger ability
- C. Intellectual isolation
- D. Savant syndrome
Correct Answer: D
Rationale: Savant Syndrome: Extraordinary proficiency in one isolated skill in individuals with multiple cognitive disabilities, often linked to autism.
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.
The caregiver for a client with moderate to severe dementia tells the nurse, 'I'm exhausted. He wanders at night instead of sleeping, so I get no rest. I'm afraid to leave him during the day, so I have to take him to the grocery store and to the laundromat. When I'm busy there, he often wanders off. Still, I have to do it all.' The nurse recognizes the need to provide teaching for this caregiver. An appropriate outcome is that the caregiver will:
- A. Develop strategies to ensure the client's safety.
- B. Seek respite care to get a break.
- C. Join a support group for caregivers.
- D. None of the above.
Correct Answer: A
Rationale: The correct answer is A: Develop strategies to ensure the client's safety. This is the most appropriate outcome as it directly addresses the caregiver's concerns of the client wandering and ensures their safety. By developing strategies such as installing door alarms, creating a safe sleeping environment, and establishing a routine, the caregiver can mitigate the risks associated with wandering behavior.
Summary:
- B: Seek respite care to get a break: While respite care is important for caregiver well-being, it does not directly address the safety concerns of the client wandering.
- C: Join a support group for caregivers: While support groups can be beneficial for emotional support, they may not provide immediate solutions to ensure the client's safety.
A client with schizophrenia is medication compliant and has well-controlled symptoms. He has, however, never been successful in holding a job because of poor social skills and lack of understanding of basic job skills. The nurse case manager should consider referring the client:
- A. To a day hospital program
- B. For psychosocial rehabilitation
- C. For cognitive therapy
- D. To assertiveness training
Correct Answer: B
Rationale: The correct answer is B: For psychosocial rehabilitation. This option is the best choice as it focuses on improving the client's social skills and job-related abilities through structured programs. Psychosocial rehabilitation helps individuals with mental health conditions develop the necessary skills for successful integration into the community, including job skills training and social skill development. Referring the client to a day hospital program (A) may not address the specific needs related to job skills and social skills. Cognitive therapy (C) primarily focuses on addressing cognitive distortions and may not directly target the client's social and job-related deficits. Assertiveness training (D) may be helpful, but it may not address the broader range of skills needed for successful job placement and retention.
Select the best comment for a nurse to begin an interview with an elderly patient.
- A. I am a nurse. Are you familiar with what nurses do?
- B. Hello. I am going to ask you some questions to get to know you better.
- C. You look comfortable and ready to participate in an admission interview. Shall we get started?
- D. Hello. My name is_____ and I am a nurse. How you would like to be addressed by staff?
Correct Answer: D
Rationale: The correct answer is D because it establishes the nurse's identity and shows respect by asking the patient's preference for addressing them. This approach sets a positive tone and promotes patient-centered care. Option A is incorrect as it assumes the patient's familiarity with nurses. Option B lacks professionalism and fails to acknowledge the purpose of the interview. Option C assumes the patient's readiness without confirming it directly and may come off as presumptuous.