Age Specific Considerations in Patient Care

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A client with obsessive-compulsive personality disorder seeks treatment for depression after the recent breakup of a relationship. The client constantly procrastinated about proposing marriage and said his girlfriend complained that he did not show her affection and that he was too controlling. Now he describes inability to sleep, poor concentration, and loss of energy since the breakup. Which outcome is a priority for the client? The client will:

  • A. Demonstrate assertive behavior
  • B. Express hope for developing a new relationship in the future
  • C. Identify feelings of sadness related to the failed relationship
  • D. List three new ways to reduce stress
Correct Answer: C

Rationale: The correct answer is C: Identify feelings of sadness related to the failed relationship. This is the priority outcome because the client's current symptoms of depression, such as inability to sleep, poor concentration, and loss of energy, are likely related to the breakup. By identifying and processing feelings of sadness, the client can begin to work through the grief and emotional distress caused by the failed relationship, which can help alleviate the depressive symptoms.

Choice A (Demonstrate assertive behavior) is not the priority outcome as the client's primary issue is related to depression and processing emotions, not assertiveness. Choice B (Express hope for developing a new relationship in the future) may be important for the client's overall well-being, but it is not the immediate priority for addressing the current depressive symptoms. Choice D (List three new ways to reduce stress) may be helpful in managing symptoms, but it does not address the core issue of processing emotions related to the breakup.

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The nurse is assessing a client who will be having an orthopedic surgery. The client takes an antipsychotic medication and shares that he has recently started using two herbal preparations for his nerves. The nurse should:

  • A. Ask for the specific names of the herbal compounds
  • B. Go on to another interview question since herbal compounds are not important
  • C. Tell him to stop using the herbal preparations because they are not effective
  • D. Explain that his physician will not be happy with his self-prescribing
Correct Answer: A

Rationale: Rationale:
A: Asking for the specific names of the herbal compounds is important to assess potential interactions with the antipsychotic medication.
B: Ignoring the herbal compounds could lead to adverse effects or interactions during surgery.
C: Telling him to stop may not be appropriate without knowing the specific compounds and their effects.
D: Discussing the physician's viewpoint is not as crucial as gathering information on potential interactions.

A patient received maintenance doses of fluphenazine decanoate (Prolixin Decanoate) 25 mg IM every 2 weeks for 2 years. The clinic nurse notes the patient is grimacing and seems to be constantly smacking her lips. On the next clinic visit, the patient's neck and shoulders twist in a slow, snakelike motion. The nurse should suspect the presence of ______ and should ______.

  • A. agranulocytosis"¦check the patient's complete blood count for changes
  • B. tardive dyskinesia"¦administer the Abnormal Involuntary Movement Scale
  • C. Tourette's syndrome"¦consult the patient's physician about a neuro evaluation
  • D. anticholinergic effects"¦consult the physician about possible medication changes
Correct Answer: B

Rationale: The correct answer is B: tardive dyskinesia"¦administer the Abnormal Involuntary Movement Scale.

1. Tardive dyskinesia is a side effect of long-term use of antipsychotic medications like fluphenazine.
2. The symptoms described - grimacing, lip smacking, twisting neck and shoulders - are characteristic of tardive dyskinesia.
3. Administering the Abnormal Involuntary Movement Scale is the appropriate assessment tool for diagnosing tardive dyskinesia.
4. Agranulocytosis (choice A) is a rare but serious side effect of some antipsychotic medications, not associated with the symptoms described.
5. Tourette's syndrome (choice C) typically presents with vocal and motor tics, not the specific symptoms mentioned.
6. Anticholinergic effects (choice D) can cause dry mouth, constipation, and blurred vision, but not the involuntary movements described.

Attention Deficit Hyperactivity Disorder (ADHD) is equally common in boys and girls

  • A. TRUE
  • B. FALSE
Correct Answer: B

Rationale: ADHD is more commonly diagnosed in boys than girls, though it affects both genders.

A patient with schizophrenia who admits to auditory hallucinations anxiously tells the nurse, 'The voice is telling me to do things.' Which of the following responses should the nurse make next?

  • A. Do you recognize the voice you hear?'
  • B. How long has this been happening?'
  • C. Does what the voice tells you to do frighten you?'
  • D. What is the voice telling you to do?'
Correct Answer: D

Rationale: The correct answer is D: "What is the voice telling you to do?" This response helps the nurse assess the content and potential danger of the hallucinations, guiding further interventions. Option A focuses on recognition, which is less urgent. Option B addresses duration, not immediate safety. Option C inquires about fear but does not directly address the hallucination's content. By asking what the voice commands, the nurse gains crucial insight for risk assessment and safety planning.

A person diagnosed with a serious mental illness (SMI) living in the community was punched, pushed to the ground, and robbed of 7 during the day on a public street. Which statements about violence and serious mental illness in general are accurate? Select one tha does not apply.

  • A. Persons with SMI are more likely to be violent
  • B. SMI persons experience higher rates of sexual assault and victimization than others
  • C. Impaired judgment and social skills can provoke hostile or assaultive behavior
  • D. Lower incomes force SMI persons to live in high-crime areas, increasing risk
Correct Answer: A

Rationale: Mentally ill persons are more likely to be victims of crime than perpetrators of criminal acts. They are often victims of criminal behavior, including sexual crimes, at a higher rate than others. When a mentally ill person commits a crime, it is usually nonviolent. Mental illnesses interfere with employment and are associated with poverty, limiting SMI persons to living in inexpensive areas that also tend to be higher-crime areas. SMI persons may inadvertently provoke others because of poor judgment or socially inappropriate behavior, or they may be victimized because they are perceived as passive, less likely to resist, and less likely to be believed as witnesses.

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