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A female client is brought to the emergency department after police officers found her disoriented, disorganized, and confused. The RN also determines that the client is homeless and is exhibiting suspiciousness. The client’s plan of care should include what priority problem?
- A. Acute confusion.
- B. Ineffective community coping
- C. Disturbed sensory perception.
- D. Self-care deficit.
Correct Answer: A
Rationale: The correct answer is A: Acute confusion. This is the priority problem because the client is disoriented, disorganized, and confused, indicating an altered mental status requiring immediate attention. Addressing acute confusion is crucial to ensure the client's safety and well-being.
Incorrect Choices:
B: Ineffective community coping is not the priority as the client's immediate cognitive impairment takes precedence.
C: Disturbed sensory perception does not align with the client's presentation of confusion and disorientation.
D: Self-care deficit may be a concern but is secondary to the acute confusion that needs urgent intervention.
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Which characteristic in an adolescent female is sometimes associated with the prodromal phase of schizophrenia?
- A. Always afraid another student will steal her belongings.
- B. An unusual interest in numbers and specific topics.
- C. Demonstrates no interest in athletics or organized sports.
- D. Appears more comfortable among males.
Correct Answer: A
Rationale: The correct answer is A because paranoia and irrational fear can be early signs of prodromal phase of schizophrenia. This can manifest as the constant fear of belongings being stolen. Choice B is incorrect as it suggests autistic traits, not specific to schizophrenia. Choice C is incorrect as lack of interest in sports is not directly linked to schizophrenia. Choice D is incorrect as comfort among males is not a defining characteristic of the prodromal phase of schizophrenia.
Which factors tend to increase the difficulty of diagnosing young children who demonstrate behaviors associated with mental illness? Select all that apply.
- A. Limited language skills
- B. Level of cognitive development
- C. Level of emotional development
- D. Parental denial that a problem exists
Correct Answer: B
Rationale: The correct answer is B: Level of cognitive development. Diagnosing mental illness in young children is challenging due to their limited ability to express their thoughts and emotions. Their cognitive development affects their capacity to understand and communicate symptoms, making it harder to assess their mental health accurately. Limited language skills (A) and emotional development (C) can also contribute to the difficulty of diagnosis, but cognitive development plays a more significant role. Parental denial (D) may hinder seeking help but is not a factor that directly impacts the diagnostic process in the child.
A female patient diagnosed with schizophrenia has been prescribed a first-generation antipsychotic medication. What information should the nurse provide to the patient regarding her signs and symptoms?
- A. Her memory problems will likely decrease.
- B. Depressive episodes should be less severe.
- C. She will probably enjoy social interactions more.
- D. She should experience a reduction in hallucinations.
Correct Answer: D
Rationale: The correct answer is D: She should experience a reduction in hallucinations. First-generation antipsychotic medications are primarily used to target positive symptoms of schizophrenia, such as hallucinations. These medications work by blocking dopamine receptors in the brain, which can help reduce hallucinations. Providing this information to the patient is crucial for managing expectations and understanding the potential benefits of the prescribed medication.
Choices A, B, and C are incorrect because first-generation antipsychotics do not specifically address memory problems, depressive episodes, or social interactions. While some side effects of the medication may impact these areas, the primary focus is on reducing hallucinations and other positive symptoms of schizophrenia. It is important for the nurse to provide accurate information to the patient to ensure effective treatment and management of their condition.
A psychiatric nurse is reviewing prescriptions for a patient with major depression at the county clinic. Since the patient has a mild intellectual disability, the nurse would question which classification of antidepressant drugs:
- A. Selective serotonin reuptake inhibitors
- B. Monoamine oxidase inhibitors
- C. Serotonin and norepinephrine reuptake inhibitors
- D. All of the above
Correct Answer: B
Rationale: The correct answer is B: Monoamine oxidase inhibitors. Due to the patient's mild intellectual disability, MAOIs would be questioned because they have a higher risk of adverse effects, dietary restrictions, and drug interactions compared to other antidepressants. Selective serotonin reuptake inhibitors (Choice A) and serotonin and norepinephrine reuptake inhibitors (Choice C) are safer options for patients with intellectual disabilities as they have fewer side effects and interactions. Choice D is incorrect as all categories of antidepressants may not be suitable for the patient.
Which student behavior is consistent with therapeutic communication?
- A. Offering your opinion when asked to convey support.
- B. Summarizing the essence of the patient’s comments in your own words.
- C. Interrupting periods of silence before they become awkward for the patient.
- D. Telling the patient he did well when you approve of his statements or actions.
Correct Answer: B
Rationale: The correct answer is B: Summarizing the essence of the patient's comments in your own words. This behavior is consistent with therapeutic communication as it shows active listening and understanding of the patient's feelings and thoughts. By summarizing, the healthcare provider demonstrates empathy and helps clarify any misunderstandings.
A: Offering your opinion when asked to convey support may not always align with therapeutic communication, as it can shift the focus from the patient to the provider's perspective.
C: Interrupting periods of silence before they become awkward for the patient can disrupt the patient's thought process and hinder open communication.
D: Telling the patient he did well when you approve of his statements or actions may come across as judgmental and can limit the patient's ability to express themselves fully.