A patient with rheumatoid arthritis reports, For the past month I've had trouble falling asleep. When I finally get to sleep, I wake up several times during the night. Which information should the nurse seek initially?

Correct Answer: D

Rationale: The correct initial information the nurse should seek is whether the patient has pain at night (choice D). Pain is a common symptom in rheumatoid arthritis that can disrupt sleep. By understanding the presence and severity of pain at night, the nurse can assess the impact on the patient's sleep quality and develop appropriate interventions. Choices A, B, and C are not as crucial initially because addressing the pain issue is fundamental in managing the patient's sleep disturbances in the context of rheumatoid arthritis.

Correct Answer: D

Rationale: The correct answer is D: "Does anyone else in your family have this problem?" This question is crucial for assessing restless legs syndrome (RLS) because RLS can have a genetic component. By asking if anyone else in the family has experienced similar symptoms, the nurse can determine if there is a familial pattern of RLS, which can help in diagnosing and managing the condition. A: "What type of birth control do you use?" This question is unrelated to RLS and does not provide relevant information for assessing the client's symptoms. B: "How much caffeine do you use every day?" While caffeine consumption can potentially impact sleep, it is not directly related to RLS symptoms involving sensations of rubber bands in the legs. C: "How much exercise do you get in a typical day?" While exercise can influence sleep patterns, it is not a key assessment question for RLS specifically.

Correct Answer: A

Rationale: The correct answer is A. Before discharge, creating a behavioral contract with rules, rewards, and consequences is crucial for maintaining progress made in the residential program. This helps the adolescent and parents establish clear expectations and boundaries, promoting consistency and accountability. Choice B is incorrect because although having positive influences is important, it is not a specific outcome that must be achieved before discharge. Choice C is incorrect as it involves temporary placement with a foster family, which may not be necessary if the adolescent and parents can work together effectively. Choice D is incorrect as it sets an unrealistic and arbitrary expectation of experiencing no anger or frustration for a week, which may not be achievable or sustainable.

Correct Answer: C

Rationale: The correct answer is C: Defensive coping related to inappropriate methods of seeking parental attention as evidenced by acting out. This is the most applicable nursing diagnosis because the adolescent is using inappropriate methods (prostitution and assault) to seek attention due to feeling neglected by their parents. The adolescent's behavior is a manifestation of coping with their perceived lack of attention from their parents. A: Disturbed personal identity is incorrect because the primary issue is not related to personal identity but rather seeking attention. B: Hopelessness related to achievement of role identity is incorrect because the main issue is not feeling unloved but seeking attention through negative behaviors. D: Impaired parenting related to inequitable feelings toward children is incorrect as it focuses on the parents' behavior rather than the adolescent's coping mechanism.

Correct Answer: D

Rationale: The correct answer is D, providing dialectical behavioral therapy (DBT). Advanced practice nurses have specialized training and skills to provide psychotherapy interventions like DBT. DBT is an evidence-based therapy specifically designed to help individuals with impulse control disorders. Leading an activity group (choice A) and providing positive feedback (choice B) can be done by both advanced practice and staff nurses. Formulating nursing diagnoses (choice C) is within the scope of both roles but does not directly address the therapeutic intervention needed for impulse control disorders.