ANCC IQ domain 2

In the aftermath of a tornado that destroyed over 100 homes in a rural Midwest community, the PMHNP draws on principles of crisis intervention while working with an elderly couple who lost everything in the storm during the night. Which of the following statements is most appropriate at the initial encounter? - What is your biggest concern right now? I will help you as much as you can. - Tell me everything that happened. We'll sort through the next steps. - You will be able to stay in the shelter until the FEMA trailers arrive. It's going to be OK. - What medications were you taking? Let me work on that first. - Answer- - What is your biggest concern right now? I will help you as much as you can. Rationale: Principles of crisis intervention guide the PMHNP to focus on one of the individual's primary concerns at a time offering direct, realistic information, and emotional support. Do not give false reassurance which blocks communication; you don't know whether everything will be resolved, and in this scenario, nothing can replace a lifetime of treasures and memories lost in their home. Do not focus on all implications at once or ask the individual to describe all of the losses or implications; this will be too overwhelming. While concerns about medication is important, first the PMHNP needs to assess what the primary concern is for this couple before addressing the medication issue. 1. During an initial assessment, the PMHNP asks the patient to perform the serial 7's. What aspect of the mental status exam would the nurse practitioner be assessing? - Concentration - Affect - Memory - Speech - Answer- - Concentration Rationale: Subtracting serial 7's from 100 is a simple task that requires intact concentration and cognitive capabilities. A 31-year old married woman with a history of anorexia nervosa, binging-purging type, during her teens and early 20's, is pregnant. She has had two prior spontaneous abortions in late 20's. She is worried whether this pregnancy may trigger recurrence of her prior eating disorder, adversely impact fetal development, or affect the likelihood of full-term delivery. At 5'7" she maintains a weight of 120 pounds by running 6-10 miles daily as conditioning for marathons and a 2,000 calorie daily vegan diet. What lifestyle modifications would reduce risks of exacerbating an eating disorder and increasing likelihood of normal fetal development and full-term delivery? - Increase daily caloric intake by 250 calories, reduce running to 4-8 miles daily with reduction in second or third trimester, add pre-natal vitamin, Calcium supplement, and plan a 20-30# gradual weight gain over the course of pregnancy. - Increase daily caloric intake by 1,000 calories, continue running as tolerated with reduction in second or third trimester, add pre-natal vitamin, vitamin E supplement, and B-complex supplement, plan a 20-30# gradual weight gain over the course of pregnancy. - Increase daily caloric intake by 500 calories, reduce running to 2-4 miles daily, alternate with stretching and yoga in second and third trimesters, add pre-natal vitamin and vitamin b-12 supplement, plan a 28-40# gradual weight gain over the course of pregnancy. - Answer- - Increase daily caloric intake by 500 calories, reduce running to 2-4 miles daily, alternate with stretching and yoga in second and third trimesters, add pre-natal vitamin and vitamin b-12 supplement, plan a 28-40# gradual weight gain over the course of pregnancy. Rationale: At 1