Nokea
A male client with schizophrenia is demonstrating echolalia, which is becoming annoying to other clients on the unit. What intervention is best for the nurse to implement?
- A. Avoid recognizing the behavior.
- B. Isolate the client from other clients.
- C. Administer a PRN sedative.
- D. Escort the client to his room.
Correct Answer: D
Rationale: The correct answer is D: Escort the client to his room. Echolalia is a common symptom of schizophrenia, where the individual repeats words or phrases they hear. Escorting the client to his room provides a safe and appropriate environment for the client to engage in the behavior without bothering other clients. Avoiding recognition (choice A) may not address the behavior and could lead to escalation. Isolating the client (choice B) may be seen as punitive and could worsen the client's symptoms. Administering a sedative (choice C) should be a last resort and not the initial intervention for managing echolalia.
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Gilbert, age 19, is described by his parents as a 'moody child' with an onset of odd behavior about at age 14, which caused Gilbert to suffer academically and socially. Gilbert has lost the ability to complete household chores, is reluctant to leave the house, and is obsessed with the locks on the windows and doors. Due to Gilbert’s early and slow onset of what is now recognized as schizophrenia, his prognosis is considered:
- A. Favorable with medication
- B. In the relapse stage
- C. Improvable with psychosocial interventions
- D. To have a less positive outcome
Correct Answer: D
Rationale: The correct answer is D: To have a less positive outcome. Gilbert's symptoms of odd behavior, academic decline, social withdrawal, inability to perform household chores, and obsession with locks are indicative of schizophrenia, a severe and chronic mental disorder. Onset at a young age and slow progression are associated with a poorer prognosis. Medication can help manage symptoms but may not completely alleviate them. Psychosocial interventions may offer some support but are unlikely to significantly alter the course of the illness. The relapse stage implies some improvement followed by worsening, which is not described in Gilbert's case. Therefore, option D is the most appropriate as it reflects the challenging nature of schizophrenia in young individuals like Gilbert.
Which nursing intervention is particularly well chosen for addressing a population at high risk for developing schizophrenia?
- A. Screening a group of males between the ages of 15 and 25 for early symptoms.
- B. Forming a support group for females aged 25 to 35 who are diagnosed with substance use issues.
- C. Providing a group for patients between the ages of 45 and 55 with information on coping skills that have proven to be effective.
- D. Educating the parents of a group of developmentally delayed 5- to 6-year-olds on the importance of early intervention.
Correct Answer: A
Rationale: The correct answer is A. Screening a group of males between the ages of 15 and 25 for early symptoms is well chosen for addressing a population at high risk for developing schizophrenia because schizophrenia commonly first appears in late adolescence to early adulthood. By screening this specific age group, healthcare providers can identify early symptoms, provide early intervention, and potentially prevent or delay the onset of schizophrenia. This proactive approach aligns with evidence-based practices in mental health care.
Summary of why the other choices are incorrect:
B: Forming a support group for females aged 25 to 35 with substance use issues is not directly addressing the high-risk population for developing schizophrenia.
C: Providing coping skills information to patients between 45 and 55 is not targeting the age group most at risk for developing schizophrenia.
D: Educating parents of developmentally delayed children on early intervention is important but not specific to addressing the high-risk group for schizophrenia.
Which characteristic in an adolescent female is sometimes associated with the prodromal phase of schizophrenia?
- A. Always afraid another student will steal her belongings.
- B. An unusual interest in numbers and specific topics.
- C. Demonstrates no interest in athletics or organized sports.
- D. Appears more comfortable among males.
Correct Answer: A
Rationale: The correct answer is A because paranoia and irrational fear can be early signs of prodromal phase of schizophrenia. This can manifest as the constant fear of belongings being stolen. Choice B is incorrect as it suggests autistic traits, not specific to schizophrenia. Choice C is incorrect as lack of interest in sports is not directly linked to schizophrenia. Choice D is incorrect as comfort among males is not a defining characteristic of the prodromal phase of schizophrenia.
Cognitive-behavioral therapy is going well when a 12-year-old patient in therapy reports to the nurse practitioner:
- A. I was so mad I wanted to hit my mother.
- B. I thought that everyone at school hated me. That’s not true. Most people like me and I have a friend named Todd.
- C. I forgot that you told me to breathe when I become angry.
- D. I scream as loud as I can when the train goes by the house.
Correct Answer: B
Rationale: The correct answer is B because it demonstrates cognitive restructuring in cognitive-behavioral therapy. The patient challenges their negative thought ("everyone hates me") with evidence to the contrary ("most people like me and I have a friend named Todd"). This shows progress in changing maladaptive thought patterns.
Choice A indicates potential aggression, choice C suggests poor retention of coping strategies, and choice D implies a maladaptive coping mechanism. Overall, B is the correct choice as it aligns with the goals of cognitive-behavioral therapy to challenge and reframe negative thoughts.
Adolescents often display fluctuations in mood along with undeveloped emotional regulation and poor tolerance for frustration. Emotional and behavioral control usually increases over the course of adolescence due to:
- A. Limited executive function
- B. Cerebellum maturation
- C. Cerebral stasis and hormonal changes
- D. A slight reduction in brain volume
Correct Answer: B
Rationale: The correct answer is B: Cerebellum maturation. During adolescence, the cerebellum undergoes significant development, leading to improved emotional and behavioral control. The cerebellum plays a crucial role in coordinating movement and regulating emotions. As it matures, adolescents become better at processing and responding to emotions, leading to increased emotional regulation and tolerance for frustration. Limited executive function (choice A) would actually hinder emotional control. Cerebral stasis and hormonal changes (choice C) do not directly contribute to improved emotional regulation. A slight reduction in brain volume (choice D) is not associated with increased emotional control.