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Which of the following statements best describes the Montreal Cognitive Assessment (MoCA) examination?
- A. Scores below 30 indicate cognitive impairment.
- B. It is a good tool to evaluate mood and thought processes.
- C. It is a good tool to detect delirium and dementia and to differentiate these from psychiatric mental illness.
- D. It is useful for an initial evaluation of mental health. Additional tools are needed to evaluate changes in cognition over time.
Correct Answer: C
Rationale: The correct answer is C because the Montreal Cognitive Assessment (MoCA) is specifically designed to detect delirium and dementia and differentiate these conditions from psychiatric mental illness. It assesses various cognitive domains such as memory, attention, language, and visuospatial abilities. Scores below the normal range on the MoCA can indicate cognitive impairment related to delirium or dementia.
Choice A is incorrect because a score below 30 on the MoCA does not necessarily indicate cognitive impairment; it depends on the individual's baseline and education level.
Choice B is incorrect because the MoCA primarily focuses on cognitive function rather than mood and thought processes.
Choice D is incorrect because while the MoCA can be used for initial evaluation of cognitive function, it is not sufficient for evaluating changes over time. Additional tools and assessments are needed for longitudinal monitoring of cognitive changes.
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A 70-year-old woman who loves to garden has small, flat, brown macules over her arms and hands. She asks, "What causes these liver spots?' The nurse tells her:
- A. They are signs of decreased hematocrit related to anemia.
- B. They are due to destruction of melanin in your skin due to exposure to the sun.
- C. They are clusters of melanocytes that appear after prolonged sun exposure.
- D. They are areas of hyperpigmentation related to decreased perfusion and vasoconstriction.
Correct Answer: C
Rationale: The correct answer is C because the small, flat, brown macules described are consistent with lentigines (commonly known as age or liver spots), which are clusters of melanocytes that appear after prolonged sun exposure. This explanation directly addresses the patient's question about the cause of the spots and is supported by the clinical presentation.
Choice A is incorrect because decreased hematocrit related to anemia would not cause these specific skin changes. Choice B is incorrect as destruction of melanin due to sun exposure would result in lighter spots, not dark brown macules. Choice D is incorrect because hyperpigmentation related to decreased perfusion and vasoconstriction would present differently and not primarily on sun-exposed areas like the arms and hands.
A 16-year-old boy has just been admitted for overnight observation after being in an automobile accident. What is the nurse's best approach to communicating with him?
- A. Use periods of silence to communicate respect for him.
- B. Be totally honest with him, even if the information is unpleasant.
- C. Tell him that everything that is discussed will be kept totally confidential.
- D. Use slang language when possible to help him open up.
Correct Answer: B
Rationale: The correct answer is B: Be totally honest with him, even if the information is unpleasant. This is the best approach because honesty builds trust and credibility, crucial in a healthcare setting. It allows the teenager to make informed decisions about his care and fosters a therapeutic relationship.
Explanation for why the other choices are incorrect:
A: Using periods of silence may be misinterpreted as indifference or lack of engagement.
C: Promising total confidentiality may not be feasible in healthcare settings and could lead to potential harm if critical information needs to be shared with others for the patient's safety.
D: Using slang language may come across as unprofessional and may hinder effective communication and understanding between the nurse and the patient.
Which of the following is the best choice for an opening statement with a patient who is in distress?
- A. "Nancy, my name is Mrs. C."
- B. "Hello, Mrs. H., my name is Mrs. C. It sure is cold today!"
- C. "Mrs. H., my name is Mrs. C. I'll need to ask you a few questions about what happened."
- D. "Mrs. H., my name is Mrs. C. I'll need to ask you a few questions about what happened."
Correct Answer: D
Rationale: The correct answer is D because it directly acknowledges the patient's distress and sets the stage for gathering essential information. By stating the need to ask questions about what happened, it shows empathy and readiness to provide help. Choice A is too formal and lacks empathy. Choice B shifts the focus away from the patient's distress. Choice C is similar to D but lacks the crucial element of acknowledging the patient's emotional state. Thus, D is the best choice for an opening statement in this scenario.
A patient describes an unreasonable, irrational fear of snakes. The feeling is so persistent that he can no longer even look at pictures of snakes without feeling uncomfortable. He has tried to identify all the places where he might encounter snakes and avoids them. The nurse recognizes that:
- A. He has a snake phobia.
- B. He is a hypochondriac. Snakes are usually harmless.
- C. He has an obsession. In this case, it is about snakes.
- D. He has a delusion that snakes are harmful. It must stem from an early traumatic incident involving snakes.
Correct Answer: A
Rationale: The correct answer is A: He has a snake phobia. Phobias are irrational and persistent fears of specific objects or situations. In this case, the patient's fear of snakes is unreasonable and causes discomfort even when encountering pictures of snakes. This aligns with the characteristics of a phobia.
Choice B is incorrect as hypochondriasis involves excessive worry about having a serious illness despite medical reassurance. Choice C is incorrect as obsessions are intrusive thoughts that cause anxiety, while the patient's fear of snakes is more of a specific fear rather than an obsession. Choice D is incorrect as delusions are fixed false beliefs, and the patient's fear of snakes is not based on a false belief but rather an irrational fear.
A nurse is teaching a patient with hypertension about lifestyle modifications. Which of the following dietary changes should the nurse emphasize?
- A. Increase intake of foods high in sodium.
- B. Decrease intake of saturated fats.
- C. Increase intake of processed foods.
- D. Decrease intake of fiber.
Correct Answer: B
Rationale: The correct answer is B: Decrease intake of saturated fats. Saturated fats can raise cholesterol levels, leading to increased risk of heart disease and hypertension. Decreasing intake of saturated fats can help lower blood pressure.
Incorrect choices:
A: Increasing intake of foods high in sodium can worsen hypertension by increasing blood pressure.
C: Increasing intake of processed foods often leads to higher sodium and saturated fat intake, worsening hypertension.
D: Decreasing intake of fiber is not ideal as fiber helps in maintaining a healthy weight and managing blood pressure.