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A patient diagnosed with schizophrenia has had multiple relapses. The patient usually responds quickly to antipsychotic medication but soon discontinues the medication. Discharge plans include follow-up at the mental health center, group home placement, and a psychosocial day program. Which strategy should apply as the patient transitions from hospital to community?
- A. Administer a second-generation antipsychotic to help negative symptoms.
- B. Use a quick-dissolving medication formulation to reduce checking.
- C. Prescribe a long-acting intramuscular antipsychotic medication.
- D. Involve the patient in decisions about which medication is best.
Correct Answer: D
Rationale: Involving the patient in medication decisions (D) builds trust and alliance, key to adherence. Other options (A, B, C) are useful but secondary to establishing this foundation.
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A client with a personality disorder asks the nurse, 'Is it true I have an inherited brain disorder?' The nurse replies, knowing that:
- A. There is proof that personality disorders are inherited
- B. All persons with personality disorders display brain abnormalities
- C. Individuals with personality disorders show an error in brain glucose metabolism
- D. Individuals with personality disorders manifest some biological markers
Correct Answer: D
Rationale: Rationale:
D is correct because individuals with personality disorders can manifest biological markers indicating a potential biological basis for the disorder. This does not imply that all individuals with personality disorders display brain abnormalities (B), have errors in brain glucose metabolism (C), or that there is definitive proof of inheritance (A). Biological markers suggest a potential biological component but do not guarantee inheritance or specific brain abnormalities.
A patient has not come out of her room for breakfast. The nurse finds the patient moving restlessly about her room in a disorganized manner. The patient is talking to herself, and her verbal responses to the nurse are nonsensical and suggest disorientation. The nurse notices that the patient's skin is hot and dry, and her pupils are somewhat dilated. All these symptoms are significant departures from the patient's recent presentation. The patient is likely experiencing ______, and the nurse should ______.
- A. anticholinergic toxicity"¦check vital signs and prepare to use a cooling blanket stat
- B. relapse of her psychosis"¦administer PRN antipsychotic drugs and notify her physician
- C. neuroleptic malignant syndrome"¦contact her physician for a transfer to intensive care
- D. agranulocytosis"¦hold her antipsychotic and draw blood for a complete blood count
Correct Answer: A
Rationale: The correct answer is A: anticholinergic toxicity. The patient's symptoms align with this diagnosis due to the disorganized behavior, nonsensical speech, disorientation, hot and dry skin, dilated pupils, and recent presentation changes. Anticholinergic toxicity can cause confusion, delirium, hyperthermia, and dilated pupils. Checking vital signs and preparing to use a cooling blanket are appropriate actions to manage the symptoms.
Choice B (relapse of psychosis) is incorrect because the symptoms are not typical of a psychotic relapse. Choice C (neuroleptic malignant syndrome) is incorrect as the symptoms do not completely align with this syndrome, which typically includes muscle rigidity and autonomic dysfunction. Choice D (agranulocytosis) is incorrect because it presents with low white blood cell count and not the symptoms described in the scenario.
A nurse finds a patient with anorexia nervosa vigorously exercising before gaining the agreed-upon weekly weight. Select the nurse's best comment.
- A. It bothers me to see you exercising.
- B. You and I will have to sit down and discuss this problem.
- C. Let's discuss the relationship between exercise and weight loss and how that affects your body.
- D. According to our agreement, exercising is not permitted until you have gained a specific amount of weight.
Correct Answer: D
Rationale: The correct answer is D because it directly addresses the behavior in relation to the agreed-upon plan and sets clear boundaries. By stating that exercising is not permitted until the patient has gained a specific amount of weight, the nurse reinforces the importance of following the treatment plan to ensure the patient's health and well-being.
A: This response does not address the behavior in a constructive manner and may come across as judgmental.
B: While discussing the problem is important, it does not provide clear guidance on addressing the immediate issue of exercising before reaching the weight goal.
C: While discussing the relationship between exercise and weight loss can be helpful, it does not provide a clear directive on what action should be taken in this specific situation.
For which behavior(s) would limit setting be most essential?
- A. A patient clings to the nurse and asks for advice about inconsequential matters.
- B. A woman is flirtatious and provocative toward staff members of the opposite sex.
- C. An elderly man displays hypervigilance and refuses to attend unit activities.
- D. A young woman urges a suspicious patient to hit anyone who stares at him.
Correct Answer: D
Rationale: The correct answer is D because it involves a behavior that is potentially harmful and puts others at risk. Setting limits is essential to prevent violence and protect both the patient and others. A: Clinging behavior is not inherently harmful. B: Flirtatious behavior, while inappropriate, does not pose a direct threat. C: Hypervigilance and refusal to attend activities may indicate underlying issues but do not require immediate limit setting for safety.
A boy with a conduct disorder diagnosis would be most likely to have which symptom?
- A. Withdrawal
- B. Ritualistic behavior
- C. Class bully
- D. Class clown
Correct Answer: C
Rationale: A pattern of bullying is a common sign of conduct disorder. Responses A and B may reflect autism.