Nurse Kenzo is teaching a client about sertraline (Zoloft), which has been prescribed for depression. A significant side effect is an interference with sexual arousal by inhibiting erectile function. How should the Nurse Kenzo approach this topic?
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Solution
Nurse Kenzo should advise the client to report any changes in sexual functioning in case medication adjustments are needed.
Clients commonly discontinue medications to avoid or correct sexual side effects, but they are less likely to do that when health professionals offer assistance with sexual issues. Generally, clients avoid discussing sexual issues unless health professionals give permission by raising the issue first.
David is preoccupied with numerous bodily complaints even after a careful diagnostic workup reveals no physiologic problems. Which nursing intervention would be therapeutic for him?
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Solution
Acknowledge that the complaints are real to the client, and refocus the client on other concerns and problems.
After physical factors are ruled out, somatic complaints are thought to be expressions of anxiety. The complaints are real to the client, but the nurse should not focus on them. Prompting the client about other concerns will encourage the expression of anxiety and dependency needs.
During a mother’s class, the nurse who is teaching the participants on stress management is questioned about the use of alternative treatments, such as herbal therapy and therapeutic touch. She explains that the advantage of these methods would include all of the following except:
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Solution
they usually work better than traditional medical practice.
Complementary alternative medicine treatments are often used as adjuncts to traditional medical treatment. Although an individual may choose a particular alternative treatment method, there is really no current scientific proof that these methods will work better than traditional medicine.
Mr. Bartowski who is newly diagnosed with rheumatoid arthritis asks the community nurse how stress can affect his disease. The nurse would explain that:
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Solution
Stress can overburden the body’s immune system, and therefore one can experience increased symptoms.
The stress response causes stimulation of the hypothalamic-pituitary-adrenal axis, which can further compromise an immune system that has been activated by the autoimmune disorder of rheumatoid arthritis. Consequently, the client can expect disease symptoms to exacerbate when under stress.
The school nurse assesses for anorexia nervosa in an adolescent girl. Which of the following findings are characteristic of this disorder? Select all that apply.
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Solution
Answer: A, B, E, F
These are all characteristics of anorexia nervosa.
Option C is common for somatoform pain disorder.
Option D is common in hypochondriasis.
The psychoanalytic theory explains the etiology of anorexia nervosa as:
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Solution
a conflict between mother and child over separation and individualization.
According to psychoanalytic theory, early mother-child dynamics lead to difficulty with a child establishing a sense of separateness from the mother. Control of eating becomes one area in which the child establishes a sense of independence.
Option A is the behavioral view of anorexia nervosa.
Option C reflects the family theory view of anorexia nervosa, which deals with the issue of lack of generational boundaries.
Option D characterizes the sociocultural view of anorexia nervosa, which identifies thinness as being a culturally determined ideal.
Nurse Ginia understands that her client Glenda who is bulimic feels shame and guilt over binge eating and purging. This disorder is therefore considered:
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Solution
Ego-dystonic.
An ego-dystonic disorder is one in which the client views behaviors or symptoms as incongruent with self-image and therefore feels guilt, shame, and distress about the symptoms. An ego-syntonic disorder is one which the client views behaviors as congruent with her self-image (as in anorexia nervosa).
Nurse Wayne is planning a psychoeducational discussion for a group of adolescent clients with anorexia nervosa. Which of the following topics would Nurse Wayne select to enhance understanding about central issues in this disorder?
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Solution
Self-control and self-esteem
Self-control and self-esteem are central issues for clients with eating disorders. Such clients feel a loss of self-control over their life and experience diminished self-esteem and severe doubts about their self-worth.
Which of the following attitudes from a nurse would hinder a discussion with an adolescent client about sexuality?
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Solution
Moralistic
Adolescents are not likely to feel free to ask questions and participate in a discussion if the nurse has a moralistic attitude toward sexual issues. Having an accepting, matter-of-fact, or nonjudgmental attitude will be helpful in allowing adolescents to feel comfortable discussing sexual issues.
The nurse evaluates the treatment of Mrs. Montez with somatoform disorder as successful if:
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Solution
Mrs. Montez verbalizes anxiety directly rather than displacing it.
Mrs. Montez with somatoform disorder unconsciously displaces anxiety onto physical symptoms. The ability to recognize and verbalize anxious feelings directly rather than displacing them is a criterion of treatment success.
Options A and C indicate the continuation of the problem.
Marlyn is diagnosed with anorexia nervosa and is admitted to the special eating disorder unit. The initial treatment priority for her is:
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Solution
To initiate a refeeding program.
The physical need to reestablish near-normal weight takes priority because of the physiologic, life-threatening consequences of anorexia.
Nurse Kerrick observes Toni who is hospitalized on an eating disorder unit during mealtimes and for 1 hour after eating. An explanation for this intervention is:
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Solution
To prevent purging behaviors.
Toni may experience increased anxiety during treatment and, therefore, may resume behaviors designed to prevent weight gain, such as vomiting or excessive exercise.
Jordanne is a client with a fear of air travel. She is being treated in a mental institution for phobic disorder. The treatment method involves systematic desensitization. The nurse would consider the treatment successful if:
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Solution
Jordanne takes a short trip in an airplane.
Systematic desensitization is a behavioral technique in which the client with a specific phobia is gradually able to work through hierarchal fears until the most fearful situation is encountered. In this case, the most fearful is riding an airplane.
The responses in options A and D may occur earlier in treatment, but not indicative of success. Generally, a phobic individual recognizes that his fear is disproportionate to the things he fears.
Mr. Johnson is newly admitted to a psychiatric unit because of severe obsessive-compulsive behavior. Which initial response by the nurse would be most therapeutic for him?
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Solution
Accepting the client’s ritualistic behaviors
It is important to accept the client’s need to perform ritualistic behaviors in this situation; admission to a psychiatric unit is stressful, and this client will tend to increase rituals when anxious. Other options are not appropriate for a newly admitted client.