Which of the following behaviors is most consistent with bulimia nervosa?
- A. Severe food restriction and extreme weight loss.
- B. Binge eating followed by vomiting or use of laxatives.
- C. Excessive exercise and rigid dietary rules.
- D. Overeating and no attempts to control food intake.
Correct Answer: B
Rationale: The correct answer is B: Binge eating followed by vomiting or use of laxatives. This behavior is most consistent with bulimia nervosa as it involves recurrent episodes of binge eating followed by compensatory behaviors like self-induced vomiting or laxative use. This pattern of behavior is a key diagnostic criteria for bulimia nervosa.
A: Severe food restriction and extreme weight loss is more indicative of anorexia nervosa, not bulimia nervosa.
C: Excessive exercise and rigid dietary rules may be seen in various eating disorders, but it is not specific to bulimia nervosa.
D: Overeating without attempts to control food intake is more characteristic of binge eating disorder, not bulimia nervosa.
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A patient asks, 'What advantage does a durable power of attorney for health care have over a living will?' The nurse should reply, 'A durable power of attorney for health care:
- A. gives your agent authority to make decisions during any illness if you are incapacitated
- B. can be given only to a relative, usually the next of kin, who has your best interests at heart
- C. can be used only if you have a terminal illness and become incapacitated
- D. cannot be implemented until 30 days after the documents are signed
Correct Answer: A
Rationale: A durable power of attorney for health care is an instrument that appoints a person other than a health care provider to act as an individuals agent in the event that he or she is unable to make medical decisions. No waiting period is required for it to become effective, and the individual does not have to be terminally ill or incompetent for the person appointed to act on the individuals behalf.
A nurse is working with a perpetrator of family violence who has a long history of violent rages when frustrated, with periods of remorse after each outburst. The nurse is most likely to establish the nursing diagnosis of:
- A. Risk for injury related to victim reprisal.
- B. Risk for other-directed violence related to stress.
- C. Ineffective coping related to poor anger management.
- D. Caregiver role strain related to feelings of being overwhelmed.
Correct Answer: C
Rationale: The correct answer is C: Ineffective coping related to poor anger management. This nursing diagnosis is appropriate because it addresses the perpetrator's inability to manage their anger effectively, leading to violent outbursts. The perpetrator's history of violent rages and subsequent remorse suggest a pattern of maladaptive coping mechanisms. This diagnosis focuses on the underlying issue of poor anger management, which is essential to address in order to prevent future acts of violence.
Choices A, B, and D are incorrect:
A: Risk for injury related to victim reprisal - This choice places the focus on potential harm to the victim as a result of retaliation, which is not the primary issue in this scenario.
B: Risk for other-directed violence related to stress - While stress may contribute to the perpetrator's behavior, the primary issue lies in their poor anger management rather than just stress.
D: Caregiver role strain related to feelings of being overwhelmed - This choice is not appropriate as it does not address the core issue of poor
A drug causes muscarinic receptor blockade. The nurse will assess the patient for
- A. Dry mouth.
- B. Gynecomastia.
- C. Pseudoparkinsonism.
- D. Orthostatic hypotension.
Correct Answer: A
Rationale: The correct answer is A: Dry mouth. Muscarinic receptor blockade inhibits the action of acetylcholine, leading to decreased salivary gland secretion and causing dry mouth. Gynecomastia (B) is associated with antiandrogen medications. Pseudoparkinsonism (C) is a side effect of antipsychotic medications that block dopamine receptors. Orthostatic hypotension (D) is a side effect of alpha-1 adrenergic receptor blockade.
A 72-year-old patient has the medical diagnosis of delirium secondary to anticholinergic medication toxicity. Family members are very anxious and express their concerns about placing the patient in a nursing home. What information should serve as a basis for the nurse's reply?
- A. Delirium is reversible, and the patient will likely recover.
- B. The symptoms are related to depression, which can be treated.
- C. Delirium usually progresses to dementia, which is usually permanent.
- D. Home care should be attempted; a nursing home should be the last resort.
Correct Answer: A
Rationale: Correct Answer: A
Rationale:
1. Delirium is an acute, reversible condition caused by underlying factors like medication toxicity.
2. By addressing the anticholinergic medication toxicity, the delirium can be resolved, leading to recovery.
3. The patient's age does not necessarily indicate a progression to dementia.
4. Placing the patient in a nursing home is not the immediate solution; resolving the toxicity should be the priority.
Summary:
Choice A is correct because delirium is reversible with appropriate treatment. Choices B, C, and D are incorrect because they do not address the underlying cause of delirium or provide accurate information about its progression or management.
One bed is available on the eating disorders unit. Which patient should be admitted? The patient whose assessment findings show the weight dropped from:
- A. 150 to 102 pounds over a 4-month period.
- B. 120 to 90 pounds over a 3-month period.
- C. 130 to 100 pounds over a 2-month period.
- D. None of the above.
Correct Answer: A
Rationale: The correct answer is A because the patient has experienced a significant weight drop from 150 to 102 pounds over a 4-month period. This represents a loss of 48 pounds over a relatively longer period, indicating a more severe and prolonged issue with weight loss. The other choices show weight drops of 30 pounds over 3 months (B) and 30 pounds over 2 months (C), which are also concerning but not as severe or long-lasting as the situation described in choice A. Choice D is incorrect as at least one patient should be admitted based on the information provided.
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