The parents of a child with ADHD bring the child for a follow-up visit. During the visit, they tell the nurse that the child receives his first dose of methylphenidate (Ritalin) at about 7:30 AM every morning before leaving for school. The teacher and school nurse have noticed a return in the child's overactivity and distractibility just before lunch. The child's second dose is scheduled for about 12 noon. Which of the following might the nurse suggest as a possible solution to control the child's symptoms a bit more effectively?

Correct Answer: B

Rationale: The correct answer is B: Switching to a longer acting preparation. By switching to a longer-acting preparation of methylphenidate, the child will receive a sustained release of the medication throughout the day, which can help control symptoms more effectively. This would prevent the dip in medication effectiveness before lunch. A: Giving the second dose at 1 PM or later may not be as effective in maintaining symptom control throughout the school day. C: Splitting the early morning dose in half may not provide consistent symptom control throughout the day. D: Switching to another class of medication is not necessary if the child is responding well to methylphenidate, and a longer-acting preparation of the same medication can be a more appropriate solution.

Correct Answer: C

Rationale: The correct answer is C: Brahmans. In Hinduism, Brahmans are considered the highest caste due to their traditional role as priests and scholars who perform religious rituals and preserve sacred knowledge. They are tasked with upholding spiritual and moral values in society. Kshatriyas are the warrior caste, Vaisyas are the merchant and farmer caste, and Untouchables are considered outside the caste system and historically faced discrimination. Brahmans hold the highest social status and are respected for their spiritual knowledge and leadership in religious practices.

Correct Answer: B

Rationale: The correct answer is B because in stepfamilies, caring for the children can be a primary stressor to the marital partners due to the complexities of blending different family dynamics. This can lead to increased tension and challenges in the relationship, impacting mental health. Explanation: 1. Stepfamilies involve integrating individuals from previous relationships, leading to potential conflicts and adjustments. 2. Caring for children from previous relationships can create additional stress and strain on the marital partners. 3. Balancing different parenting styles and expectations can lead to disagreements and increased stress levels. 4. These stressors can contribute to mental health issues such as anxiety, depression, and relationship conflicts within stepfamilies. Summary: Choice A is incorrect as it generalizes about middle-aged childless adults without considering individual circumstances. Choice C is incorrect as separation due to relocation may not always result in additional support from extended family. Choice D is incorrect as mental health outcomes in same-sex families can vary and may not always demonstrate lower rates of depression

Correct Answer: A

Rationale: The correct answer is A: Gabapentin. Gabapentin is a medication commonly used to treat neuropathic pain, which is often associated with chronic pain in older patients. It is considered a safer alternative to opioids due to its lower risk of addiction and overdose. Acetaminophen (B) is an over-the-counter pain reliever but may not be sufficient for chronic pain. Morphine (C) and Fentanyl (D) are opioids, which have a higher risk of side effects, addiction, and overdose compared to Gabapentin. Therefore, Gabapentin is the most suitable choice for managing chronic pain in older patients.

Correct Answer: C

Rationale: The correct technique for de-escalating a client with OCPD experiencing extreme anxiety is employing active listening. Active listening involves fully concentrating, understanding, responding, and remembering what the client is saying. This technique can help the client feel heard, validated, and understood, which can reduce their anxiety. It also allows the client to express their thoughts and feelings, promoting a sense of control and autonomy. This approach is client-centered and respectful, aligning with the principles of effective therapy for OCPD. Summary: A: Physically directing the client may increase their anxiety and worsen the situation. B: Holding steady eye contact may be perceived as confrontational and intrusive, escalating the client's anxiety. D: Taking control and instructing the client may trigger resistance and exacerbate feelings of lack of control, which are common in OCPD.