ATI RN
Age Specific Considerations in Patient Care Questions
Question 1 of 5
An older adult patient who lives with a daughter and attends the Alzheimer day hospital program exhibits bilateral bruising for the second time on both upper outer arms. When the nurse questions the patient about the bruising, the patient starts to cry and pleads, 'Please don't say anything. It's not my daughter's fault. I just bruise easily.' Which intervention reflects the best management of this situation?
Correct Answer: B
Rationale: The correct answer is B: Report the elder abuse and inform the patient and the daughter of your intention. This is the best intervention as it prioritizes the safety and well-being of the older adult. Here's the rationale: 1. The patient's repeated bruising and fear of disclosure indicate potential abuse. 2. Reporting elder abuse is mandatory to ensure protection for the patient. 3. Informing the patient and daughter shows transparency and involves them in the process. 4. It is crucial to address the situation promptly to prevent further harm. Summary: A: Calling the daughter may escalate the situation and compromise the patient's safety. C: Notifying the social worker without addressing the abuse directly may delay necessary action. D: Counseling may be beneficial, but addressing the abuse is a priority to ensure the patient's safety.
Question 2 of 5
A client has been admitted with disorganized type schizophrenia. The nurse observes blunted affect and social isolation. The client occasionally curses or calls another client a 'jerk' without provocation. The nurse asks the client how he is feeling, and he responds, 'Everybody picks on me. They frobitz me.' The best response for the nurse to make would be:
Correct Answer: B
Rationale: The correct answer is B: "Who do you mean when you say 'everybody'?" Rationale: 1. Clarifying the client's statement helps to understand his perception. 2. Asking specifically about 'everybody' encourages the client to express his feelings and thoughts. 3. It promotes therapeutic communication by showing empathy and active listening. Incorrect choices: A: "That's really too bad." - This response does not address the client's specific concerns or promote further exploration. C: "What difference does frobitzing make?" - This response is dismissive and lacks empathy or understanding of the client's experience. D: "Why do they frobitz?" - This response is confrontational and may come across as accusatory, potentially shutting down communication.
Question 3 of 5
A salesman has had difficulty holding a job because he accuses co-workers of conspiring to take his sales. Today, he argued with several office mates and threatened to kill one of them. The police were called, and he was brought to the mental health center for evaluation. He has had previous admissions to the unit for stabilization of paranoid schizophrenia. When the nurse meets him, he points at staff in the nursing station and states loudly, 'They're all plotting to destroy me. Isn't that true?' Which would be the most appropriate response?
Correct Answer: C
Rationale: The correct answer is C: Thinking that people want to destroy you must be very frightening. Rationale: 1. Acknowledges the patient's feelings: By stating that thinking people want to destroy him is frightening, the nurse shows empathy and validates his experience. 2. Validates the patient's emotions: This response does not directly agree or disagree but acknowledges the emotions behind the patient's statement. 3. Builds rapport: By showing understanding and empathy, the nurse can establish trust and rapport with the patient, leading to better communication and therapeutic relationship. Summary of other options: A: This response denies the patient's feelings and could potentially escalate the situation by invalidating his experiences. B: This response may come off as confrontational and does not address the patient's underlying fears. D: This response is dismissive and does not address the patient's emotional distress, potentially leading to further agitation.
Question 4 of 5
The family of a patient with schizophrenia who has been stable for a year reports to the community mental health nurse that the patient reports feeling tense and having difficulty concentrating. He sleeps only 3 to 4 hours nightly and has begun to talk about creatures called 'volmers' hiding in the warehouse where he works and undoing his work each night. This information most likely suggests:
Correct Answer: D
Rationale: The correct answer is D: relapse of his schizophrenia. The patient's symptoms of feeling tense, difficulty concentrating, poor sleep, and delusional beliefs about creatures at work indicate a worsening of his psychotic symptoms. This suggests a relapse of schizophrenia, a chronic mental illness characterized by periods of stability and exacerbation of symptoms. The patient's previous stability for a year makes medication nonadherence less likely. While psychoeducation may be beneficial, the patient's current symptoms require more immediate intervention for relapse management. The information provided does not directly indicate the chronic nature of his illness, but rather an acute exacerbation. Therefore, D is the most appropriate choice based on the presented symptoms and clinical understanding of schizophrenia.
Question 5 of 5
An 82-year-old widow with Alzheimer's disease lives with her daughter's family, which owns a catering business. During the week, the patient attends a day care center for patients with dementia. During the evenings, members of the family care for the patient. One day, the nurse at the day care center notices the patient's appearance is disheveled and that she startles easily. She has a strong odor of urine, and her hair is uncombed. When the nurse escorts the patient to the bathroom, she notices bruises on her wrists and back. What most likely explains the nurse's observations?
Correct Answer: A
Rationale: The correct answer is A: The patient is being neglected and abused within the family. The nurse's observations of the patient's disheveled appearance, strong odor of urine, uncombed hair, and bruises indicate signs of neglect and abuse. Here's the rationale: 1. Disheveled appearance and strong odor of urine suggest lack of personal care. 2. Uncombed hair signals neglect in grooming. 3. Bruises on wrists and back are indicative of physical abuse. 4. Startling easily may be due to fear or anxiety from abuse. In summary, the other choices (B, C, D) are incorrect because they do not account for the combination of neglect, poor hygiene, and physical injuries seen in the patient, which are more indicative of abuse and neglect within the family.