Nokea
A community mental health nurse wants to establish a relationship with a very withdrawn patient diagnosed with schizophrenia. The patient lives at home with a supportive family. Select the nurse's best plan.
- A. Visit daily for 4 days, then visit every other day for 1 week; stay with the patient for 20 minutes; accept silence; state when the nurse will return.
- B. Arrange to spend 1 hour each day with the patient; focus on asking questions about what the patient is thinking or experiencing; avoid silences.
- C. Visit twice daily; sit beside the patient with a hand on the patient's arm; leave if the patient does not respond within 10 minutes.
- D. Visit every other day; remind the patient of the nurse's identity; encourage the patient to talk while the nurse works on reports.
Correct Answer: A
Rationale: Severe constraints on the community mental health nurse's time will approximately not allow more time than what is mentioned in the correct option, yet important principles can be used. A severely withdrawn patient should be met 'at the patient's own level,' with silence accepted. Short periods of contact are helpful to minimize both the patient's and the nurse's anxiety. Predictability in returning as stated will help build trust. An hour may be too long to sustain a home visit with a withdrawn patient, especially if the nurse persists in leveling a barrage of questions at the patient. Twice-daily visits are probably not possible and leaving after 10 minutes would be premature. Touch may be threatening. Working on reports suggests the nurse is not interested in the patient.
You may also like to solve these questions
A nurse works with a patient diagnosed with schizophrenia regarding the importance of medication management. The patient repeatedly says, 'I don't like taking pills.' Which treatment strategy should the nurse discuss with the patient and health care provider?
- A. Use of long-acting antipsychotic injections
- B. Addition of a benzodiazepine, such as lorazepam
- C. Adjunctive use of an antidepressant, such as amitriptyline
- D. Inpatient hospitalization because of the high risk for exacerbation of symptoms
Correct Answer: A
Rationale: Medications such as paliperidone, fluphenazine decanoate, and haloperidol decanoate are long-acting forms of antipsychotic medications. They are administered by depot injection every 2 to 4 weeks, thus reducing daily opportunities for nonadherence. The incorrect options do not address the patient's dislike of taking pills.
A patient diagnosed with schizophrenia begins to talk about 'cracklomers' in the local shopping mall. The term 'cracklomers' should be documented using what term?
- A. Neologism
- B. Concrete thinking
- C. Thought insertion
- D. An idea of reference
Correct Answer: A
Rationale: A neologism is a newly coined word having special meaning to the patient. 'Cracklomers' is not a known word. Concrete thinking refers to the inability to think abstractly. Thought insertion refers to thoughts of others that are implanted in one's mind. An idea of reference is a type of delusion in which trivial events are given personal significance.
A person diagnosed with schizophrenia has had difficulty keeping a job because of severe paranoia. Today the person shouts, 'They're all plotting to destroy me.' Select the nurse's most therapeutic response.
- A. Everyone here is trying to help you. No one wants to harm you.
- B. Feeling that people want to destroy you must be very frightening.
- C. That is not true. People here are trying to help if you will let them.
- D. Staff members are health care professionals who are qualified to help you.
Correct Answer: B
Rationale: Resist focusing on content; instead, focus on the feelings the patient is expressing. This strategy prevents arguing about the reality of delusional beliefs. Such arguments increase patient anxiety and the tenacity with which the patient holds to the delusion. The other options focus on content and provide opportunity for argument.
A patient diagnosed with schizophrenia anxiously says, 'I can see the left side of my body merging with the wall, then my face appears and disappears in the mirror.' What phenomena is the patient describing?
- A. Derealization
- B. Concrete thinking
- C. Abstract thinking
- D. Depersonalization
Correct Answer: D
Rationale: Depersonalization: a nonspecific feeling of having lost one's identity; the self is different or unreal. People may be concerned that body parts do not belong to them, or they may have an acute sensation that the body has drastically changed. Derealization is the false perception that the environment has changed. Concrete thinking refers to an overemphasis on specific details and a literal interpretation of ideas. It is contrasted with abstract thinking. People who think in an abstract way look at the broader significance of ideas and information rather than the concrete details.
A patient diagnosed with schizophrenia has auditory hallucinations, delusions of grandeur, poor personal hygiene, and motor agitation. Which assessment finding would the nurse regard as a negative symptom of schizophrenia?
- A. Auditory hallucinations
- B. Delusions of grandeur
- C. Poor personal hygiene
- D. Motor agitation
Correct Answer: C
Rationale: Negative symptoms include apathy, anhedonia, poor social functioning, and poverty of thought. Poor personal hygiene is an example of poor social functioning. The distractors are positive symptoms of schizophrenia.