Nokea
A 17-year-old patient with anorexia nervosa has just been released from the hospital. To facilitate recovery at home, the psychiatric-mental health nurse instructs the family to:
- A. discourage the patient from sneaking food between meals, by unobtrusively reducing access to the kitchen
- B. encourage the patient's interest in menu planning, food magazines, and cooking lessons, by leaving information and materials around the house
- C. permit the patient to eat her meals privately to discourage family preoccupation with meals
- D. recommend that the patient joins in routine family meals and clears the dishes after dinner, even if they do not eat
Correct Answer: D
Rationale: Involving the patient in family meals normalizes eating behavior and provides structure, supporting recovery without enabling secrecy or avoidance.
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A client displays disorganized thinking, difficult-to-follow speech, and silly, inappropriate affect. The client isolates himself from other clients and staff, ignores unit activities, and often seems to be listening and responding to unseen stimuli. This client's behavior most closely conforms to the characteristic behavior of:
- A. Residual schizophrenia
- B. Schizoaffective disorder
- C. Paranoid schizophrenia
- D. Disorganized schizophrenia
Correct Answer: D
Rationale: The correct answer is D: Disorganized schizophrenia. This client's presentation aligns with the symptoms of disorganized schizophrenia, characterized by disorganized thinking, speech, and behavior, inappropriate affect, social withdrawal, and hallucinations. Residual schizophrenia (A) refers to a milder form of schizophrenia with lingering symptoms. Schizoaffective disorder (B) involves symptoms of both schizophrenia and mood disorders. Paranoid schizophrenia (C) is characterized by delusions and auditory hallucinations, which are not the primary symptoms displayed by the client in the question.
An acutely psychotic individual diagnosed with schizophreniaform disorder at admission is immediately placed on daily doses of risperidone. A hospitalization of 8 days' duration has been authorized by the HMO. By what hospital day would the nurse expect to note that client was demonstrating beginning trust in the nurse and reduction in hallucinations and delusions?
- A. Day of admission
- B. Day 3 of hospitalization
- C. Day 5 of hospitalization
- D. Day 7 of hospitalization
Correct Answer: B
Rationale: The correct answer is B: Day 3 of hospitalization. Typically, antipsychotic medications like risperidone take a few days to start showing noticeable effects in reducing hallucinations and delusions. By day 3, the medication would have had enough time to begin its therapeutic effect. Building trust with a psychotic patient also takes time, so by day 3, the patient may start showing signs of trust in the nurse. Day of admission (Choice A) is too early for the medication to take effect. Day 5 (Choice C) and Day 7 (Choice D) are too late as the medication usually shows noticeable improvement within the first few days.
A nurse is providing education to a patient with anorexia nervosa. Which of the following statements indicates a need for further education?
- A. I understand that my body needs food to function properly.
- B. I am willing to work on gaining weight with the help of my care team.
- C. I believe that eating food will make me fat and out of control.
- D. I am ready to learn how to improve my relationship with food.
Correct Answer: C
Rationale: The correct answer is C because the statement reflects a common misconception associated with anorexia nervosa, indicating a need for further education. Here's the rationale:
1. Anorexia nervosa involves a distorted body image and fear of gaining weight.
2. Believing that eating food will make one fat and out of control aligns with these distorted beliefs.
3. This statement demonstrates a lack of understanding and acceptance of the importance of proper nutrition for health.
4. Choices A, B, and D show positive attitudes towards recovery and willingness to address the disorder, highlighting a better understanding of the condition.
In summary, choice C shows a need for further education due to the presence of distorted beliefs, while the other options reflect a more positive and informed mindset towards recovery.
The medication donepezil (Aricept) frequently is used to treat the early-stage symptoms of Alzheimer's disease. When administering this particular medication, the nurse should be especially alert to assess the client for:
- A. Weight changes
- B. Tremors
- C. Increased sweating
- D. Alterations in blood pressure
Correct Answer: D
Rationale: The correct answer is D: Alterations in blood pressure. Donepezil can cause changes in blood pressure as a side effect. Nurses should monitor for orthostatic hypotension and changes in blood pressure to prevent adverse effects. Weight changes (A), tremors (B), and increased sweating (C) are not commonly associated with donepezil and are less likely to be significant concerns when administering this medication for Alzheimer's disease.
During a treatment team meeting, the point is made that a client with schizophrenia has recovered from the acute psychosis but continues to demonstrate apathy, avolition, and blunted affect. The nurse who relates these symptoms to serotonin (SHT2) excess will suggest that the client receive:
- A. Haloperidol (Haldol)
- B. Chlorpromazine (Thorazine)
- C. Olanzapine (Zyprexa)
- D. Phenelzine (NardiI)
Correct Answer: C
Rationale: Rationale: Olanzapine (Zyprexa) is the correct choice because it is an atypical antipsychotic that targets serotonin receptors, particularly 5-HT2 receptors known to be involved in negative symptoms of schizophrenia like apathy, avolition, and blunted affect. Olanzapine's mechanism of action helps alleviate these symptoms by modulating serotonin levels in the brain.
Incorrect Choices:
A: Haloperidol and B: Chlorpromazine are typical antipsychotics that primarily target dopamine receptors and are less effective in treating negative symptoms associated with schizophrenia.
D: Phenelzine is a monoamine oxidase inhibitor used to treat depression and anxiety disorders, not schizophrenia symptoms related to serotonin excess.