Nokea
A nurse is caring for a patient diagnosed with schizophrenia. Which of the following behaviors would the nurse most likely observe in this patient?
- A. Excessive energy and impulsive behavior.
- B. Difficulty in maintaining eye contact and speaking in a monotone voice.
- C. Inability to distinguish between reality and fantasy.
- D. Hyperactivity and racing thoughts.
Correct Answer: C
Rationale: Schizophrenia often causes impairments in reality testing, and patients may have difficulty distinguishing between real and imagined experiences, which can lead to delusions and hallucinations.
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A patient diagnosed with major depressive disorder is receiving imipramine 200 mg every night at bedtime. Which assessment finding would prompt the nurse to collaborate with the health care provider regarding potentially hazardous side effects of this drug?
- A. Dry mouth
- B. Blurred vision
- C. Nasal congestion
- D. Urinary retention
Correct Answer: D
Rationale: Imipramine, a tricyclic antidepressant, can cause urinary retention as a side effect. This can lead to complications like urinary tract infections or discomfort and requires prompt attention.
A patient diagnosed with schizophrenia lives in the community. On a home visit, the community psychiatric nurse case manager learns that the patient: wants to attend an activity group at the mental health outreach center, is worried about being able to pay for the therapy, does not know how to get from home to the outreach center, has an appointment to have blood work at the same time an activity group meets, wants to attend services at a church that is a half-mile from the patients home. Which tasks are part of the role of a community mental health nurse?Select one that does not apply.
- A. Rearranging conflicting care appointments
- B. Negotiating the cost of therapy for the patient
- C. Arranging transportation to the outreach center
- D. Accompanying the patient to church services weekly
Correct Answer: D
Rationale: The correct answers reflect the coordinating role of the community psychiatric nurse case manager. Negotiating the cost of therapy and accompanying the patient to church services are interventions the nurse would not be expected to undertake. The patient can walk to the church services; the nurse can provide encouragement.
Which assessment finding for a patient in the community deserves priority intervention by the psychiatric nurse? The patient:
- A. receives Social Security disability income plus a small check from a trust fund every month.
- B. was absent from two of six planned Alcoholics Anonymous meetings in the past 2 weeks.
- C. lives in an apartment with two patients who attend partial hospitalization programs.
- D. has a sibling who was recently diagnosed with a mental illness.
Correct Answer: B
Rationale: Patients who use alcohol or illegal substances often become medication noncompliant. Medication noncompliance, along with the disorganizing influence of substances on cellular brain function, promotes relapse. The distracters do not suggest problems.
A patient with fears of serious heart disease was referred to the mental health center by a cardiologist. Extensive diagnostic evaluation showed no physical illness. The patient says, "My chest is tight, and my heart misses beats. I'm often absent from work. I don't go out much because I need to rest." Which health problem is most likely?
- A. Dysthymic disorder
- B. Somatic symptom disorder
- C. Antisocial personality disorder
- D. Illness anxiety disorder (hypochondriasis)
Correct Answer: D
Rationale: Illness anxiety disorder (hypochondriasis) involves preoccupation with fears of having a serious disease even when evidence to the contrary is available. The preoccupation causes impairment in social or occupational functioning. Somatic symptom disorder involves fewer symptoms. Dysthymic disorder is a disorder of lowered mood. Antisocial disorder applies to a personality disorder in which the individual has little regard for the rights of others. See relationship to audience response question.
A patient being discharged appears angry with the nurse when the nurse attempts to review discharge instructions with the patient. The nurse can best assist the patient in this stage of the relationship with which of the following responses?
- A. We have to go over these instructions before you can go. Please try to listen.'
- B. Would you rather not be discharged today?'
- C. I can sense you are angry this morning. Tell me how you feel about being discharged today.'
- D. You should be able to regulate your feelings better by now. Why are you angry?'
Correct Answer: C
Rationale: Both nurse and client usually have feelings about ending the relationship; the client especially may feel the termination as an impending loss. Often clients try to avoid termination by acting angry or as if the problem has not been resolved. The nurse can acknowledge the client's angry feelings and assure the client that this response is normal to ending a relationship. If the client tries to reopen and discuss old resolved issues, the nurse should identify the client's stalling maneuvers and refocus the client on newly learned behaviors and skills to handle the problem.