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A patient with schizophrenia is experiencing auditory hallucinations. Which nursing intervention is most appropriate?
- A. Encourage the patient to ignore the voices.
- B. Provide a structured and safe environment.
- C. Engage the patient in a debate about the reality of the voices.
- D. Ask the patient to describe the content of the hallucinations.
Correct Answer: D
Rationale: The most appropriate nursing intervention when a patient with schizophrenia is experiencing auditory hallucinations is to ask the patient to describe the content of the hallucinations. This intervention helps assess the risk associated with the hallucinations and provides valuable insight into the patient's condition, aiding in developing an effective care plan. Encouraging the patient to ignore the voices (Choice A) may not address the underlying issues or risks associated with the hallucinations. Providing a structured and safe environment (Choice B) is important but does not directly address the hallucinations. Engaging the patient in a debate about the reality of the voices (Choice C) may worsen the situation by invalidating the patient's experiences.
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What information should the nurse include in patient education for a patient prescribed fluoxetine for obsessive-compulsive disorder (OCD)?
- A. Take the medication in the morning to avoid insomnia.
- B. The medication may take several weeks to achieve the full effect.
- C. It is safe to consume alcohol while taking this medication.
- D. Report any side effects to the healthcare provider immediately.
Correct Answer: B
Rationale: Patients prescribed fluoxetine should be educated that the medication may take several weeks to achieve its full therapeutic effect. This information helps manage patient expectations and ensures they do not discontinue the medication prematurely due to lack of immediate results. Taking the medication in the morning to avoid insomnia is not a specific requirement for fluoxetine. Consuming alcohol while taking fluoxetine is not safe and can lead to adverse effects. It is crucial to report any side effects to the healthcare provider promptly for timely management and adjustment of the treatment plan.
Which medication is commonly prescribed for the treatment of panic disorder?
- A. Haloperidol
- B. Clonazepam
- C. Lithium
- D. Fluoxetine
Correct Answer: B
Rationale: Clonazepam, a benzodiazepine, is commonly prescribed for the treatment of panic disorder due to its anxiolytic properties. It helps reduce the frequency and intensity of panic attacks by acting on the central nervous system to produce a calming effect. Haloperidol is an antipsychotic medication, lithium is primarily used for bipolar disorder, and fluoxetine is a selective serotonin reuptake inhibitor (SSRI) commonly used for depression and some anxiety disorders, but not as a first-line treatment for panic disorder.
When assessing a patient with schizophrenia who exhibits flat affect and social withdrawal, these symptoms are classified as:
- A. Positive symptoms
- B. Negative symptoms
- C. Cognitive symptoms
- D. Mood symptoms
Correct Answer: B
Rationale: Flat affect and social withdrawal are characteristic of negative symptoms in schizophrenia. Negative symptoms involve disruptions to normal emotions and behaviors, such as reduced emotional expression (flat affect) and social withdrawal. These symptoms reflect a decrease or absence of normal functions. Positive symptoms, on the other hand, involve the presence of abnormal behaviors or experiences, such as hallucinations and delusions, which are added to a person's experiences. Cognitive symptoms relate to difficulties with thinking, memory, and processing information, impacting cognition. Mood symptoms involve disturbances in mood regulation, which is distinct from the flat affect seen in negative symptoms.
During a manic episode in bipolar disorder, which intervention is most appropriate for a patient?
- A. Encourage the patient to engage in group activities.
- B. Provide a structured and low-stimulus environment.
- C. Allow the patient to set their schedule.
- D. Engage the patient in high-energy physical activities.
Correct Answer: B
Rationale: During a manic episode in bipolar disorder, individuals may experience heightened energy levels, impulsivity, and decreased need for sleep. Providing a structured and low-stimulus environment is crucial in managing manic episodes. This intervention helps reduce overstimulation and provides a calm and predictable setting, which can be beneficial in helping the patient regain control and stability. Group activities and high-energy physical activities may exacerbate the symptoms of mania by increasing stimulation and excitement. Allowing the patient to set their schedule may not provide the necessary structure needed during a manic episode, hence making it less appropriate.
A patient with obsessive-compulsive disorder (OCD) is performing a ritualistic handwashing routine. What is the nurse's best initial response?
- A. Interrupt the ritual to help the patient gain control.
- B. Allow the ritual but set limits on the duration.
- C. Ignore the behavior to avoid reinforcing it.
- D. Encourage the patient to stop the ritual and discuss their feelings.
Correct Answer: B
Rationale: In managing a patient with OCD engaging in ritualistic behaviors like handwashing, the nurse's best initial response is to allow the ritual but set limits on the duration. This approach helps in managing the behavior while gradually working towards reducing its frequency. Interrupting the ritual abruptly may cause distress to the patient, ignoring the behavior may reinforce it, and encouraging the patient to stop the ritual without setting limits may not be as effective in the initial stage of intervention.