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Which would be the best initial approach for a nurse to select when managing the care of an individual with two children who works full-time and has been abused by a partner?
- A. Teach the individual how to avoid provoking the abuser.
- B. Assist the individual in filing a police report describing the abuse.
- C. Help the individual to identify needs in order to best obtain support.
- D. Facilitate the individual's move into a safe house located near the current workplace.
Correct Answer: C
Rationale: The correct answer is C: Help the individual to identify needs in order to best obtain support. This is the best initial approach because it focuses on understanding the individual's specific needs and circumstances before taking any further action. By identifying needs, the nurse can create a tailored plan to provide appropriate support and resources.
Option A is incorrect because teaching the individual to avoid provoking the abuser places the responsibility on the victim rather than addressing the root cause of the abuse. Option B, filing a police report, may not be the best initial step as it may not take into consideration the individual's safety concerns or emotional well-being. Option D, moving the individual to a safe house, may not be feasible or desired by the individual without first understanding their needs and preferences.
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According to Freud, an individual who experiences problems during the phallic stage of development may have a poorly developed superego. This construct is most relevant to planning care for a client who has the DSM-IV-TR diagnosis of:
- A. Obsessive-compulsive personality disorder
- B. Schizoid personality
- C. Borderline personality disorder
- D. Antisocial personality disorder
Correct Answer: D
Rationale: Step 1: Freud's phallic stage is when the superego develops.
Step 2: Antisocial personality disorder is associated with a poorly developed superego.
Step 3: Individuals with antisocial personality disorder often lack empathy and have a disregard for rules.
Step 4: This behavior aligns with Freud's concept of a weak superego.
Step 5: Therefore, the correct answer is D, Antisocial personality disorder.
Summary: A: Obsessive-compulsive personality disorder is characterized by perfectionism, not related to a weak superego. B: Schizoid personality is marked by social detachment, not directly linked to superego development. C: Borderline personality disorder involves instability in relationships and self-image, not specifically tied to superego development.
A nurse conducts group therapy on the eating disorders unit. Sessions are scheduled immediately after meals. What is the rationale?
- A. Provide a forum for journaling about foods eaten.
- B. Shift the patients' focus from food to psychotherapy.
- C. Promote processing of anxiety associated with eating.
- D. Focus on weight control mechanisms and food preparation.
Correct Answer: C
Rationale: The correct answer is C because scheduling group therapy sessions immediately after meals can help promote processing of anxiety associated with eating. This timing allows patients to address their feelings and thoughts about food in a supportive environment, leading to better understanding and management of their anxieties. Choice A is incorrect because journaling about foods eaten is not the primary purpose of group therapy sessions. Choice B is incorrect as the main focus is on addressing anxiety related to eating disorders, not shifting focus to psychotherapy. Choice D is incorrect as weight control mechanisms and food preparation are not the main objectives of group therapy for eating disorders.
A newly admitted client has the diagnosis of catatonic schizophrenia. The nurse would expect to assess:
- A. Psychomotor symptoms
- B. Intense suspiciousness
- C. Inappropriate affect
- D. Clanging communication
Correct Answer: A
Rationale: Rationale:
A: Psychomotor symptoms are characteristic of catatonic schizophrenia, such as stupor or excessive motor activity.
B: Intense suspiciousness is more indicative of paranoid schizophrenia, not catatonic schizophrenia.
C: Inappropriate affect is a symptom seen in other types of schizophrenia but not specific to catatonic schizophrenia.
D: Clanging communication is associated with disorganized schizophrenia, not catatonic schizophrenia.
In catatonic schizophrenia, psychomotor symptoms like stupor, rigidity, or excitement are prominent.
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 patient with many positive symptoms of schizophrenia, whose behavior is disorganized and who is highly anxious, tells the nurse in the psychiatric emergency department, 'You have got to help me. I do not know what is going on. I think someone is trying to wipe me out. I have to get a gun.' The patient, a college student, lives alone and has no family or support system in the immediate area. He has not left his room in 2 weeks, has not eaten in several days, and is unkempt. Of the available treatment settings, the nurse should recommend:
- A. admission to an unlocked residential crisis unit.
- B. inpatient hospitalization on a locked unit.
- C. attending a day treatment program for 4 weeks.
- D. admission to a partial hospital program.
Correct Answer: B
Rationale: The correct answer is B: inpatient hospitalization on a locked unit. This option is the most appropriate because the patient is presenting with severe symptoms of schizophrenia, including paranoia, disorganized behavior, and potential harm to self or others by mentioning getting a gun. In this case, the patient requires a higher level of care and safety, which can only be provided in an inpatient hospital setting on a locked unit. Admission to an unlocked residential crisis unit (Choice A) may not provide the necessary level of supervision and security. Attending a day treatment program for 4 weeks (Choice C) may not be intensive enough to address the patient's current crisis. Admission to a partial hospital program (Choice D) also may not provide the required level of supervision and structure for a patient with such acute symptoms.