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A 19-year-old client is admitted for the second time in 9 months and is acutely psychotic with a diagnosis of undifferentiated schizophrenia. The client sits alone rubbing her arms and smiling. She tells the nurse her thoughts cause earthquakes and that the world is burning. The nurse assesses the primary deficit associated with the client's condition as:
- A. Altered mood states
- B. Disturbed thinking
- C. Social isolation
- D. Poor impulse control
Correct Answer: B
Rationale: The correct answer is B: Disturbed thinking. In this scenario, the client's belief that her thoughts cause earthquakes and the world is burning are examples of delusions, which are a key symptom of schizophrenia. This demonstrates a disturbance in the client's thought process, indicating a primary deficit in thinking. Altered mood states (A) may be present as well but are not the primary deficit in this case. Social isolation (C) is a consequence of the client's symptoms rather than the primary deficit. Poor impulse control (D) is not the primary issue presented in the scenario.
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A patient with schizophrenia has received typical (first-generation) antipsychotics for a year. His hallucinations are less intrusive, but he remains apathetic, has poverty of thought, cannot work, and is socially isolated. To address these symptoms, the nurse might consult the prescribing health care provider to suggest a change to:
- A. haloperidol (Haldol).
- B. olanzapine (Zyprexa).
- C. diphenhydramine (Benadryl).
- D. chlorpromazine (Thorazine).
Correct Answer: B
Rationale: The correct answer is B: olanzapine (Zyprexa). Olanzapine is an atypical (second-generation) antipsychotic that addresses both positive and negative symptoms of schizophrenia. In this case, the patient still experiences negative symptoms like apathy, poverty of thought, and social withdrawal. Olanzapine has been shown to be effective in improving negative symptoms and overall functioning in patients with schizophrenia.
A: haloperidol is a typical (first-generation) antipsychotic that primarily targets positive symptoms like hallucinations, not negative symptoms.
C: diphenhydramine is an antihistamine with no known efficacy for treating schizophrenia symptoms.
D: chlorpromazine is a typical antipsychotic like haloperidol and is not typically used for addressing negative symptoms.
A child, aged 11 years, stays home from school to care for his siblings while his mother works, because the family cannot afford a babysitter. The home is cluttered and dirty when the community mental health nurse visits to investigate the child's school absences. When the parents arrive home from work, the child's father behaves angrily. He orders his wife and son about. He finds fault with the son, asking him twice, 'Why are you such a stupid kid?' The wife tells the nurse she has difficulty disciplining the children and gets frustrated easily. The nurse desires to build some trust and continue to gather assessment data. The remark or question that would interfere with the nurse's goals is:
- A. Tell me what happens when the children misbehave.'
- B. When your baby cries, how do you get him to stop?'
- C. Caring for three young children must be difficult.'
- D. Do you or your husband ever beat the children?'
Correct Answer: D
Rationale: The correct answer is D. Asking about physical abuse can be perceived as accusatory, defensive, or judgmental, hindering trust-building and data collection. It may lead to denial or termination of communication. Choices A and B are relevant to understanding parenting skills, while C shows empathy. These questions align with the nurse's goal of assessing the family's dynamics without inciting defensiveness or shutting down communication.
When people successfully adapt to their environment by using logical thought and socially appropriate ways, they are said to be functioning at the adaptive end of the _____ continuum.
- A. Emotional
- B. Self-protective
- C. Neurobiological
- D. Psychobiological
Correct Answer: C
Rationale: The correct answer is C: Neurobiological. This is because neurobiological factors refer to the brain's functioning and how it affects behavior and cognition. When individuals adapt to their environment using logical thought and socially appropriate ways, it indicates a high level of cognitive and behavioral functioning, which is closely tied to neurobiological processes.
A: Emotional is incorrect because emotional factors focus on feelings and affective responses, not necessarily on logical thought and social appropriateness.
B: Self-protective is incorrect as it pertains to behaviors aimed at ensuring one's safety and security, which may not necessarily involve logical thought and social appropriateness.
D: Psychobiological is incorrect as it encompasses the interaction between psychological and biological processes, which may not specifically relate to adaptive functioning in the given context.
What is the most appropriate initial treatment goal for a patient with anorexia nervosa?
- A. Achieve rapid weight gain to restore nutritional status.
- B. Restore the patient's nutritional balance through gradual weight gain.
- C. Focus on addressing body image issues before weight gain.
- D. Encourage the patient to participate in group therapy for support.
Correct Answer: B
Rationale: The correct initial treatment goal for a patient with anorexia nervosa is to restore the patient's nutritional balance through gradual weight gain. This approach is crucial as rapid weight gain can lead to refeeding syndrome, a potentially life-threatening complication. Gradual weight gain allows the body to adjust to increased caloric intake safely. Addressing body image issues is important but can be more effectively tackled after nutritional balance is restored. Group therapy can be beneficial but should not be the primary focus initially. Thus, choice B is the most appropriate initial treatment goal.
A 16-year-old female patient who is Chinese American is admitted to the unit with reports of sadness and suicidal ideation. The patient is accompanied by many family members, including her mother and father. The patient and her family emigrated from mainland China five years ago. Regarding the family, the psychiatric-mental health nurse:
- A. encourages the patient to communicate her need for privacy to her family
- B. gently asks the family members to leave the room
- C. privately asks the mother for her assistance in clearing the room
- D. provides care for the patient while the family members are present
Correct Answer: C
Rationale: Involving the mother respects cultural family dynamics while facilitating a private assessment, balancing sensitivity and need.