A client with anorexia nervosa engages in manipulative behavior. She tells the nurse, 'I can't get weighed this morning, because I drank a glass of juice a few minutes before breakfast.' The best approach by the nurse would be:

Correct Answer: D

Rationale: Step 1: The correct answer is D because it sets clear boundaries and enforces consistency by reminding the client of the established protocol. Step 2: By stating "This is weight day. Please step on the scale," the nurse maintains the structure and accountability in the treatment plan. Step 3: This response avoids reinforcing manipulative behavior and emphasizes the importance of following the agreed-upon rules for accurate monitoring. Step 4: Other choices like A may inadvertently validate the manipulation, B suggests giving in to the client's avoidance tactic, and C delays the weighing without addressing the manipulation directly.

Correct Answer: C

Rationale: The correct answer is C because a major difference between anorexia nervosa and bulimia nervosa is that patients with bulimia are often of near-normal weight, while patients with anorexia are typically underweight. This is due to the different patterns of eating behaviors in the two disorders. In bulimia, individuals often engage in binge-eating episodes followed by compensatory behaviors such as purging, which may help maintain their weight. On the other hand, individuals with anorexia restrict their food intake significantly, leading to malnourishment and significant weight loss. Choice A is incorrect because individuals with bulimia can still experience malnourishment due to the purging behaviors. Choice B is incorrect because both patients with anorexia and bulimia may deny hunger due to their disordered eating behaviors. Choice D is incorrect because both disorders involve a distorted body image, although the specific nature of the distortion may differ.

Correct Answer: B

Rationale: The correct answer is B) Breach confidentiality to inform his parent about the adolescent's suicidal thoughts. In this scenario, the adolescent's safety is the top priority. Suicidal ideation in a minor is a serious concern that requires immediate intervention. As a healthcare provider, it is crucial to ensure the adolescent's well-being by involving the parent or guardian to provide necessary support and access to mental health resources. Option A) Referring to peds medicine for workup of obesity is not the most immediate concern in this case. While addressing obesity is important, the immediate focus should be on the adolescent's safety due to the presence of suicidal thoughts. Option C) Referring to school for counseling is not appropriate for handling suicidal ideation. School counseling may be beneficial in a comprehensive treatment plan but is not the primary step when a patient is at risk of self-harm. Option D) Providing reassurance and diet and exercise advice is inadequate when dealing with suicidal ideation. This approach does not address the urgent need for mental health intervention and parental involvement. Educationally, this scenario highlights the importance of recognizing and responding to suicidal ideation in adolescents. It emphasizes the duty of care healthcare providers have in ensuring the safety and well-being of their patients, especially when dealing with mental health concerns. Confidentiality should be breached when there is a risk of harm to the patient or others, and involving parents or guardians is crucial in providing appropriate support and intervention.

Correct Answer: B

Rationale: The correct answer is B) Assessment of oppositional behaviors should consider individual, dyadic, systemic, and familial risk factors. This answer is correct because effective management of oppositional behaviors in children requires a comprehensive assessment that takes into account various factors. Individual factors such as temperament, cognitive abilities, and emotional regulation play a role in shaping behavior. Dyadic factors refer to the child's interactions with caregivers and peers, which can influence behavior. Systemic factors include the child's environment, such as school and community dynamics. Familial risk factors like parenting styles, family dynamics, and history of mental health issues can also contribute to oppositional behaviors. Option A is incorrect because some degree of oppositional behavior is considered typical in children as they develop autonomy and test boundaries. It becomes a concern when it is persistent and disruptive. Option C is incorrect because while both psychosocial interventions (like therapy and behavior management strategies) and, in some cases, pharmacological treatments may be used, they are not equally effective for everyone and are often used in combination rather than as standalone treatments. Option D is incorrect because parenting involvement and training are crucial components in managing oppositional behaviors. Parenting strategies and behavior management techniques are often essential in helping children learn more adaptive ways of coping and interacting with others. In an educational context, understanding the multifaceted nature of oppositional behaviors and the importance of a thorough assessment can guide educators and professionals in developing targeted interventions that address the underlying factors contributing to a child's behavior. It highlights the need for a holistic approach that involves collaboration between various stakeholders to support the child effectively.

Correct Answer: D

Rationale: In this scenario, option D, where the client sees frightening faces on the wall, is indicative of an illusion. An illusion is a misinterpretation or misperception of a real external stimulus. In this case, the client is misinterpreting shadows on the wall as frightening faces, which is a classic example of an illusion. Option A, where the client tries to hit the clinical officer, suggests aggression or agitation, not an illusion. Option B, where the client hears a voice telling them to run away, could indicate auditory hallucinations, not an illusion. Option C, where the client becomes anxious when the clinical officer leaves, may point to separation anxiety or attachment issues, not illusions. Educationally, understanding the difference between illusions, hallucinations, and other perceptual disturbances is crucial in healthcare. This knowledge helps healthcare providers assess and communicate effectively with clients experiencing such phenomena, leading to better care outcomes. It also aids in accurate diagnosis and treatment planning for conditions like schizophrenia, delirium, or substance-induced disorders.