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A homeless patient diagnosed with severe and persistent mental illness became suspicious and delusional. The patient was given depot antipsychotic medication and housing was arranged at a local shelter. After 2 weeks, which statement by the patient indicates significant improvement?
- A. I am feeling safe and comfortable here. Nobody bothers me.'
- B. They will not let me drink. They have many rules in the shelter.'
- C. Those guys are always watching me. I think someone stole my shoes.'
- D. That shot made my arm sore. I'm not going to take any more of them.'
Correct Answer: A
Rationale: Evaluation of a patient's progress is made based on patient satisfaction with the new health status and the health care team's estimation of improvement. For a formerly delusional patient to admit to feeling comfortable and free of being 'bothered' by others denotes an improvement in the patient's condition. The other options suggest that the patient is in danger of relapse.
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Which information should a nurse include in health teaching for adults diagnosed with attention-deficit/hyperactivity disorder (ADHD) and their significant others?
- A. Tendency for genetic transmission
- B. Prevention strategies related to substance abuse
- C. Negative reinforcement strategies to help modify behaviors
- D. Selective serotonin reuptake inhibitors (SSRIs) are usually prescribed for hyperactivity
- E. Cognitive therapy may help resolve internalized negative beliefs about self
Correct Answer: A,B,E
Rationale: Evidence suggests that ADHD has a biological basis. This fact can help adults with the disorder to cope with low self-esteem. Cognitive therapy is helpful in reframing negative beliefs about self. Adults diagnosed with ADHD have a higher incidence of substance abuse problems. Psychostimulant medications, rather than SSRIs, are usually prescribed.
A patient tells the nurse, 'My sexual functioning is normal when my partner wears lace. Without it, I'm not interested in sex.' This comment evidences which sexual disorder?
- A. Exhibitionism
- B. Voyeurism
- C. Pedophilia
- D. Fetishism
Correct Answer: D
Rationale: A person with a sexual fetish finds it necessary to have some external object present, in fantasy or in reality, to be sexually satisfied. Exhibitionism refers to exposing one's genitalia publicly. Voyeurism refers to viewing others in intimate situations. Pedophilia refers to the preference for having sexual relations with a child.
Which statements most clearly indicate that the speaker views mental illness with stigma?
- A. Everyone is a little bit crazy.'
- B. If people with mental illness would go to church, their problems would be solved with faith.'
- C. Many mental illnesses are genetically transmitted. It is no one's fault that the illness occurs.'
- D. Anyone can have a mental illness. War or natural disasters can be too stressful for healthy people.'
- E. People with mental illness are lazy. They expect the government to take care of everything they need.'
Correct Answer: A,B,E
Rationale: Statements that trivialize mental illness ('Everyone is a little bit crazy'), suggest simplistic solutions ('go to church'), or stereotype individuals as lazy reflect stigmatizing attitudes. The other statements acknowledge the biological and situational factors of mental illness without judgment, indicating a lack of stigma.
An adult diagnosed with attention-deficit/hyperactivity disorder (ADHD) says, 'I've always been stupid. I never had friends when I was a child. My parents often punished me because I made mistakes. Now, I can't keep a job.' The nurse managing care should consider suggesting what intervention?
- A. Aversive therapy to extinguish negative behaviors.
- B. Cognitive therapy to help address internalized beliefs.
- C. Group therapy to allow comparison of feelings with others.
- D. Vocational counseling to identify needed occupational skills.
Correct Answer: B
Rationale: Cognitive therapy and knowledge of ADHD will make it possible for the patient to reframe the past and present in a more positive and realistic light and to challenge internalized false beliefs about self this improving self-image. Aversive therapy would not be useful for the patient. Group therapy may be valuable later to allow for the testing of new coping behaviors in a safe environment. Vocational counseling can help the patient explore suitable career options while pursuing treatment.
For patients diagnosed with severe and persistent mental illness, what is the major advantage of case management?
- A. Modification of traditional psychotherapy
- B. Efficient access and use of resources
- C. Focus on social skills training and self-esteem building
- D. Bringing groups of patients together to discuss common problems
Correct Answer: B
Rationale: The case manager not only provides entrance into the system of care, but he or she also coordinates the multiple referrals that so often confuse the patient who is severely and persistently mentally ill and the patient's family. Case management promotes the efficient use of services. The other options are lesser advantages or may be irrelevant.