Nokea
Which of the following will lead one to need to consider autism spectrum disorder as a likely diagnosis?
- A. A girl spoke her first words at 14 months, enjoyed playing with Peppa Pig characters at age 2 daily. She tended to sit away from her classmates at recess at age 7 but when asked, would say she had 30 friends. She was very good at the piano and had strong knowledge of all the great composers at age 8. She entered the Gifted Education Programme at 10. At 13, she did poorly at group work, often talked about death and the afterlife, and became progressively silent
- B. A boy walked at 18 months, spoke his first words at 2 , and enjoyed playing Minecraft at 4 together with his friends. He participated at birthday parties. He struggled with composition writing, both for ideas and also for the efforts in writing in school, but managed an AL score of 18 and was promoted to secondary school
- C. A boy walked at 13 months and was a happy child in preschool. He started speaking at 18 months but did not recognise letters and numbers consistently until 4.5 years of age. He did not read until 7 . He was sometimes forgetful with instructions but did not cause disruption in school, though he was often the clown in class. He tended to not finish his work unless his parents sat with him. Nonetheless, he completed primary school with some extra time for exams and went on to secondary school
- D. A girl walked at 16 months and was often clumsy though she did not fall. She would bump into things and might drop items in her hands. She disliked writing and was slow to write. She could never complete her work in class. She would shade the wrong answers on the optical answer sheet although she knew the right answers. She had trouble with mathematics thoughout school but she enjoyed reading
Correct Answer: A
Rationale: Option A shows social withdrawal, poor group interaction, and restricted interests (music, death themes), aligning with ASD criteria in DSM-5, unlike the others with more typical development or specific learning/motor issues.
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An 83-year-old man becomes lost while driving. He pulls into a driveway to turn around and cannot figure out how to put his car in reverse, so he drives into the yard, makes a circle, and drives back out of the driveway. He is stopped by police, who take him to the emergency department. The physician diagnoses him with Alzheimer's disease and refers him to the neurology clinic for follow-up. Given this diagnosis, which behaviors should the clinic nurse anticipate?
- A. Does not know today's date.
- B. Unable to shower without help.
- C. Denial of mental impairment.
- D. None of the above.
Correct Answer: A
Rationale: The correct answer is A: Does not know today's date. This behavior is commonly associated with Alzheimer's disease due to memory impairment. The inability to recall the current date is a key symptom of cognitive decline. In this case, the man's difficulty with reversing his car and getting lost are indicative of cognitive impairment.
Choice B, Unable to shower without help, is a functional impairment and not specific to Alzheimer's disease. Choice C, Denial of mental impairment, may occur in some individuals with Alzheimer's but is not a consistent behavior. Choice D, None of the above, is incorrect as memory deficits, such as not knowing the date, are commonly seen in Alzheimer's disease.
Which intervention is appropriate for a patient who has anorexia nervosa and is resisting weight gain?
- A. Assist the patient to identify triggers to binge eating.
- B. Provide remedial consequences for weight loss.
- C. Assess for signs of impulsive eating.
- D. Explore needs for health teaching.
Correct Answer: A
Rationale: The correct answer is A because assisting the patient to identify triggers to binge eating is crucial in addressing the resistance to weight gain in anorexia nervosa. By understanding the triggers, the patient can work on overcoming them and develop healthier eating habits. Option B is incorrect as providing remedial consequences for weight loss may exacerbate the issue. Option C is incorrect as impulsive eating is not the main concern in anorexia nervosa. Option D is incorrect as exploring needs for health teaching does not directly address the resistance to weight gain in anorexia nervosa.
A patient with antisocial personality disorder tells Nurse A, 'You're a much better nurse than Nurse B said you were.' The patient tells Nurse B, 'Nurse A's upset with you for some reason.' To Nurse C the patient states, 'You'd like to think you're perfect, but I've seen three of your mistakes this morning.' Which nursing intervention would be most helpful for addressing this behavior?
- A. Hold a weekly staff meeting to discuss feelings and conflicts related to such behavior.
- B. Confront the patient and advise her that if she continues this, she will lose privileges.
- C. Get all staff to agree that any and all inappropriate behavior will simply be ignored.
- D. Evaluate the patient for a medication increase or transfer to a long-term facility.
Correct Answer: A
Rationale: The correct answer is A: Hold a weekly staff meeting to discuss feelings and conflicts related to such behavior. This intervention promotes open communication among staff members to address and understand the patient's behavior. It allows for collaboration in managing challenging situations and ensures consistency in approach. Confronting the patient (B) may escalate the behavior and damage the therapeutic relationship. Ignoring inappropriate behavior (C) does not address the underlying issues and may lead to staff frustration. Evaluating for medication increase or transfer (D) should be considered only after non-pharmacological interventions have been exhausted.
A patient diagnosed with schizophrenia tells the community mental health nurse, 'I threw away my pills because they interfere with Gods voice.' The nurse identifies the etiology of the patients ineffective management of the medication regime as:
- A. inadequate discharge planning
- B. poor therapeutic alliance with clinicians
- C. dislike of antipsychotic medication side effects
- D. impaired reasoning secondary to the schizophrenia
Correct Answer: D
Rationale: The patients ineffective management of the medication regime is most closely related to impaired reasoning. The patient believes in being an exalted personage who hears Gods voice, rather than an individual with a serious mental disorder who needs medication to control symptoms. Data do not suggest any of the other factors often related to medication nonadherence.
A severely depressed patient with psychomotor retardation has begun activities therapy. His schedule is: 9 AM, ceramics; 10 AM, exercise group; 11 AM to noon, open; noon, lunch. The nurse creating the patient's schedule should opt to fill the hour block from 11 AM to noon with:
- A. Group therapy.
- B. A rest period.
- C. Reminiscence group.
- D. Individual counseling.
Correct Answer: B
Rationale: The correct answer is B: A rest period. Providing a rest period during the hour block from 11 AM to noon is crucial for a severely depressed patient with psychomotor retardation. This patient may experience fatigue and decreased energy levels due to their condition. Allowing for a rest period can help prevent overstimulation and promote relaxation, which is essential for mental well-being. Group therapy (choice A) may be too overwhelming for the patient at this time. Reminiscence group (choice C) may not be as beneficial for immediate symptom management. Individual counseling (choice D) may be helpful but may not align with the patient's immediate need for rest and relaxation.