Nokea
A nurse assesses an elderly patient. The nurse should complete the Geriatric Depression Scale if the patient answers which question affirmatively.
- A. Would you say your mood is often sad?'
- B. Are you having any trouble with your memory?'
- C. Have you noticed an increase in your alcohol use?'
- D. Do you often experience moderate to severe pain?'
Correct Answer: A
Rationale: Feeling low may be a symptom of depression. Low moods occurring with regularity should signal the need for further assessment for other symptoms of depression. The other options do not focus on mood.
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A patient has schizophrenia and is troubled by negative symptoms, muscle stiffness, and motor restlessness. His Advanced Practice Nurse (APN) is considering changing the patient's antipsychotic medication, haloperidol (Haldol, a typical or first generation antipsychotic drug). For planning purposes, which medication can the nurse assume that the APN will probably choose?
- A. Chlorpromazine (Thorazine)
- B. Clozapine (Clozaril)
- C. Olanzapine (Zyprexa)
- D. Fluoxetine (Prozac)
Correct Answer: C
Rationale: The correct answer is C: Olanzapine (Zyprexa). Olanzapine is an atypical or second-generation antipsychotic known for effectively treating negative symptoms, muscle stiffness, and motor restlessness in schizophrenia. It has a lower risk of extrapyramidal side effects compared to typical antipsychotics like haloperidol. Chlorpromazine (A) is a typical antipsychotic with similar side effect profiles as haloperidol. Clozapine (B) is an atypical antipsychotic but is typically reserved for treatment-resistant cases due to its potential for serious side effects. Fluoxetine (D) is an antidepressant and not typically used for treating the symptoms described in the question. Therefore, the APN will likely choose Olanzapine to address the patient's symptoms effectively with a lower risk of side effects.
A couple in counseling reports fighting with their child when they are angry with each other. This behavior typifies:
- A. coalition
- B. indirect communication
- C. transference
- D. triangulation
Correct Answer: D
Rationale: Triangulation occurs when a third party (the child) is drawn into a conflict between two others, redirecting tension.
The nurse manager of a mental health center wants to improve medication adherence among the seriously mentally ill persons treated there. Which interventions are likely to help achieve this goal? Select one tha does not apply
- A. Maintain stable and consistent staff
- B. Increase the length of medication education groups
- C. Stress that without treatment, illnesses will worsen
- D. Prescribe drugs in smaller but more frequent dosages
Correct Answer: A
Rationale: Trust in ones providers is a key factor in treatment adherence, and mentally ill persons can sometimes take a very long time to develop such trust; therefore, interventions which stabilize staffing allow patients to have more time with staff to develop these bonds. Ready access to prescribers allows medicine-related concerns to be addressed quickly, reducing obstacles to adherence such as side effects or ineffective dosages. Medication costs can be obstacles to adherence as well. Many SMI patients have anosognosia and do not adhere to treatment because they believe they are not ill, so telling them nonadherence will worsen an illness they do not believe they have is unlikely to be helpful. Increasing medication education is helpful only when the cause of nonadherence is a knowledge deficit. Other issues that reduce adherence, particularly anosognosia and side effects, are seldom helped by longer medication education. Requiring medication adherence to participate in other programs is coercive and unethical. Smaller, more frequent doses do not reduce side effects and make the regimen more difficult for the patient to remember.
A nurse wants to assess for suicidal ideation in an elderly patient. Select the best question to begin this assessment.
- A. Are there any things going on in your life that would cause you to consider suicide?'
- B. What are your beliefs about a persons right to take his or her own life?'
- C. Do you think you are vulnerable to developing a depressed mood?'
- D. If you felt suicidal, would you tell someone about your feelings?'
Correct Answer: B
Rationale: This question is clear, direct, and respectful. It will produce information relative to the acceptability of suicide as an option to the patient. If the patient deems suicide unacceptable, no further assessment is necessary. If the patient deems suicide as acceptable, the nurse can continue to assess intent, plan, means to carry out the plan, lethality of the chosen method, and so forth. The other options are less direct, may produce responses that may be unclear, or are appropriate for later in this discussion.
A delusion is defined as seeing something that is not real
- A. TRUE
- B. FALSE
Correct Answer: B
Rationale: A delusion is a fixed false belief, not a perception (hallucination involves seeing/hearing something not real).