Nokea
Child protective services have removed 10-year-old Christopher from his parents' home due to neglect. Christopher reveals to the nurse that he considers the woman next door his "nice" mom, that he loves school, and gets above-average grades. The strongest explanation for this response is:
- A. Temperament
- B. Genetic factors
- C. Resilience
- D. Paradoxical effects of neglect
Correct Answer: C
Rationale: Resilience is the ability to adapt well despite adversity, which is demonstrated by Christopher's positive relationships and school performance. Despite the challenging situation of being removed from his parents' home, Christopher's ability to form a positive bond with the neighbor, enjoy school, and excel academically showcases his resilience in coping with the circumstances.
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What assessment findings would indicate lithium toxicity in a patient hospitalized for an acute manic episode?
- A. Shortness of breath, gastrointestinal distress, chronic cough
- B. Ataxia, severe hypotension, large volume of dilute urine
- C. Gastrointestinal distress, thirst, nystagmus
- D. Electroencephalographic changes, chest pain, dizziness
Correct Answer: B
Rationale: In a patient suspected of lithium toxicity, the presence of ataxia, severe hypotension, and a large volume of dilute urine are key assessment findings. Ataxia is a sign of central nervous system involvement, severe hypotension indicates cardiovascular effects, and a large volume of dilute urine suggests renal impairment, all of which are commonly seen in severe lithium toxicity. Options A, C, and D do not align with typical signs of lithium toxicity.
Tomas is a 21-year-old male with a recent diagnosis of schizophrenia. Tomas's nurse recognizes that self-medicating with excessive alcohol is common in this disease and can co-occur along with:
- A. Generally good health despite the mental illness.
- B. An aversion to drinking fluids.
- C. Anxiety and depression.
- D. The ability to express his needs.
Correct Answer: C
Rationale: Individuals with schizophrenia often turn to alcohol as a form of self-medication to manage co-occurring symptoms of anxiety and depression. This coping mechanism can exacerbate the underlying mental health condition and hinder proper treatment. Recognizing and addressing these co-occurring issues are essential in providing holistic care for individuals with schizophrenia.
Carolina is surprised when her patient does not show for a regularly scheduled appointment. When contacted, the patient states, "I don't need to come see you anymore. I have found a therapy app on my phone that I love." How should Carolina respond to this news?
- A. That sounds exciting; would you be willing to visit and show me the app?
- B. At this time, there is no real evidence that the app can replace our therapy.
- C. I am not sure that is a good idea right now; we are so close to progress.
- D. Why would you think that is a better option than meeting with me?
Correct Answer: A
Rationale: Carolina should respond by showing interest in the app, as it can help maintain the therapeutic relationship and provide an opportunity to evaluate the app's effectiveness together. By asking the patient to visit and show the app, Carolina demonstrates openness to exploring new tools that the patient finds helpful, while also ensuring that the patient's well-being remains a priority. This approach fosters communication, allows for a collaborative discussion on how the app fits into the patient's treatment plan, and may potentially address any concerns or misconceptions the patient has about the app replacing traditional therapy.
Gilbert, age 19, is described by his parents as a 'moody child' with an onset of odd behavior 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: Individuals with an early and slow onset of schizophrenia typically have a less positive outcome or prognosis. This is because early onset schizophrenia is often associated with a more severe form of the illness and can lead to greater functional impairment in various aspects of life, including academic and social functioning. Therefore, the prognosis for Gilbert, given his presentation and age of onset, would be considered to have a less positive outcome.
Ted, a former executive, is now unemployed due to manic episodes at work. He was diagnosed with bipolar I 8 years ago. Ted has a history of IV drug abuse, which resulted in hepatitis C. He is taking his lithium exactly as scheduled, a fact that both Ted's wife and his blood tests confirm. To reduce Ted's mania, the psychiatric nurse practitioner recommends:
- A. Clonazepam (Klonopin)
- B. Fluoxetine (Prozac)
- C. Electroconvulsive therapy (ECT)
- D. Lurasidone (Latuda)
Correct Answer: D
Rationale: Lurasidone (Latuda) is an atypical antipsychotic medication commonly used in the treatment of bipolar disorder. It can help manage symptoms of mania by stabilizing mood and reducing the intensity of manic episodes. Given Ted's history of bipolar I disorder and the need to address his manic symptoms, Lurasidone (Latuda) is a suitable recommendation by the psychiatric nurse practitioner to aid in managing Ted's condition effectively.