An older male patient has suffered with episodic pruritus and skin eruptions for over 2 years. This patient tells the nurse, “When my skin gets better for a few days, I start worrying that it's going to start itching again soon. I think my worry may actually trigger the problems to start all over again.” Which self-help technique should the nurse consider suggesting for this patient?

Correct Answer: B

Rationale: The correct answer is B: Meditation. Meditation can help the patient manage stress and anxiety, which are known triggers for pruritus and skin eruptions. By practicing mindfulness and relaxation techniques, the patient can reduce the psychological impact of worrying about their condition, leading to potential improvement in their symptoms. Incorrect Choices: A: Melatonin is a hormone that regulates sleep-wake cycles and may not directly address the patient's psychological stress. C: Purification is a vague term and does not offer a specific technique to help the patient manage their worry and stress. D: Acupuncture may have benefits for certain conditions, but it may not specifically address the patient's psychological concerns related to their skin issues.

Correct Answer: B

Rationale: The correct answer is B: undisturbed sleep throughout the night. Valerian is commonly used as an herbal remedy for insomnia and sleep disorders. The desired outcome for a patient using valerian is to achieve improved sleep quality, characterized by uninterrupted and restful sleep throughout the night. This is because valerian has sedative properties that help promote relaxation and induce sleep. Option A is not specific to the intended use of valerian, which is primarily for sleep-related issues. Option C is not directly related to the primary purpose of valerian. Option D, early morning waking without an alarm clock, does not necessarily indicate improved sleep quality and may not be a realistic expectation for all patients. Therefore, option B is the best desired outcome for a patient using valerian to address sleep disturbances.

Correct Answer: C

Rationale: The correct answer is C: Educate the patient about the risks of selective serotonin syndrome. St. John's wort is known to interact with many medications, including paroxetine. This combination can increase serotonin levels in the brain, leading to a potentially dangerous condition called serotonin syndrome. The nurse's priority is to ensure the patient understands this risk and the importance of consulting with their healthcare provider before combining medications. Incorrect choices: A: Assess changes in the patient's level of depression. While monitoring the patient's depression is important, addressing the potential drug interaction and safety concerns takes precedence. B: Remind the patient to use a secondary form of birth control. This is not the priority in this situation as the main concern is the drug interaction. D: Suggest adding valerian to the treatment regimen to further improve results. Introducing another supplement without addressing the potential interaction with St. John's wort and paroxetine is not appropriate.

Correct Answer: A

Rationale: The correct answer is A: "I'm fat and ugly." Rationale: 1. This response indicates a distorted body image commonly seen in individuals with anorexia nervosa. 2. Anorexia nervosa is characterized by a fear of gaining weight and a preoccupation with body image. 3. The statement reflects a negative perception of oneself in terms of weight and appearance, which aligns with the psychological aspect of anorexia nervosa. 4. Other choices do not exhibit the same level of dissatisfaction with body weight and appearance as seen in anorexia nervosa.

Correct Answer: B

Rationale: The correct answer is B because involving the patient in decision making increases their sense of control and promotes adherence to treatment. By establishing a contract with the patient for a specified weekly weight gain, the patient feels empowered and motivated to actively participate in their recovery process. This sense of control can help the patient overcome resistance to weight gain and improve compliance with treatment recommendations. Explanation for other choices: A: While collecting objective and subjective data is important in managing anorexia nervosa, it does not directly address the rationale for establishing a contract with the patient. C: Consent is indeed essential for treatment, but this choice does not address the importance of patient involvement in decision making for promoting adherence to treatment. D: While a team approach to treatment planning is crucial, it does not specifically explain the rationale for establishing a contract with the patient for weight gain.