Nokea
A patient has disorganized thinking associated with schizophrenia. Neuroimaging would most likely show dysfunction in which part of the brain?
- A. Hippocampus
- B. Frontal lobe
- C. Cerebellum
- D. Brainstem
Correct Answer: B
Rationale: The correct answer is B: Frontal lobe. Disorganized thinking in schizophrenia is often associated with executive function deficits, which are primarily controlled by the frontal lobe. This area is responsible for decision-making, problem-solving, and reasoning. Dysfunction here can lead to disorganized thoughts and behaviors. The other choices, such as the hippocampus (A), involved in memory, the cerebellum (C), involved in motor coordination, and the brainstem (D), involved in basic life functions, are less likely to be directly related to disorganized thinking in schizophrenia.
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A client, age 70, was brought into the Emergency Department by family members who reported a fall. During the assessment, the nurse became suspicious that the client had suffered physical abuse. The client denied that she had been abused. Her denial is most likely based on her:
- A. Fear of retaliation.
- B. Emotional response to the situation.
- C. Cognitive impairment.
- D. None of the above.
Correct Answer: B
Rationale: The correct answer is B: Emotional response to the situation. The client's denial is likely due to emotional factors such as shame, embarrassment, or fear of causing trouble for family members. This emotional response can lead the client to deny abuse even when it has occurred. Choice A is incorrect because fear of retaliation may be a factor, but emotional response is more likely. Choice C is incorrect as cognitive impairment would affect the client's ability to understand and respond to the situation, not necessarily lead to denial. Choice D is incorrect as the client's denial is influenced by emotional factors.
A patient is admitted with a tentative diagnosis of delirium. The patient repeatedly mistakes one of the nursing staff for a family member. The nurse documents that this patient is experiencing a disturbance in which area of functioning?
- A. Consciousness
- B. Attention
- C. Perception
- D. Cognition
Correct Answer: C
Rationale: The correct answer is C: Perception. In this scenario, the patient's repeated mistake of identifying a nursing staff as a family member indicates a disturbance in perception, specifically in the recognition and interpretation of sensory information. This confusion is not related to consciousness (A), as the patient is awake and aware. It is also not solely an issue of attention (B), as attention involves the ability to focus on specific stimuli rather than the interpretation of those stimuli. While cognition (D) encompasses various mental processes, such as memory and problem-solving, the primary issue in this case is the misinterpretation of sensory input, aligning with the disturbance in perception.
A salesman has had difficulty holding a job because he accuses co-workers of conspiring to take his sales. Today, he argued with several office mates and threatened to kill one of them. The police were called, and he was brought to the mental health center for evaluation. He has had previous admissions to the unit for stabilization of paranoid schizophrenia. When the nurse meets him, he points at staff in the nursing station and states loudly, 'They're all plotting to destroy me. Isn't that true?' Which would be the most appropriate response?
- A. No, that is not true. People here are trying to help you if you will let them.'
- B. Let's think about it: what reason would people have to want to destroy you?'
- C. Thinking that people want to destroy you must be very frightening.'
- D. That doesn't make sense; staff are health care workers, not murderers.'
Correct Answer: C
Rationale: The correct answer is C: Thinking that people want to destroy you must be very frightening.
Rationale:
1. Acknowledges the patient's feelings: By stating that thinking people want to destroy him is frightening, the nurse shows empathy and validates his experience.
2. Validates the patient's emotions: This response does not directly agree or disagree but acknowledges the emotions behind the patient's statement.
3. Builds rapport: By showing understanding and empathy, the nurse can establish trust and rapport with the patient, leading to better communication and therapeutic relationship.
Summary of other options:
A: This response denies the patient's feelings and could potentially escalate the situation by invalidating his experiences.
B: This response may come off as confrontational and does not address the patient's underlying fears.
D: This response is dismissive and does not address the patient's emotional distress, potentially leading to further agitation.
A patient with schizophrenia who admits to auditory hallucinations anxiously tells the nurse, 'The voice is telling me to do things.' Which of the following responses should the nurse make next?
- A. Do you recognize the voice you hear?'
- B. How long has this been happening?'
- C. Does what the voice tells you to do frighten you?'
- D. What is the voice telling you to do?'
Correct Answer: D
Rationale: The correct answer is D: "What is the voice telling you to do?" This response helps the nurse assess the content and potential danger of the hallucinations, guiding further interventions. Option A focuses on recognition, which is less urgent. Option B addresses duration, not immediate safety. Option C inquires about fear but does not directly address the hallucination's content. By asking what the voice commands, the nurse gains crucial insight for risk assessment and safety planning.
A 17-year-old client is admitted to the ED after being alternately hyperalert and difficult to arouse. His symptoms all started within the last few hours, during which time he became agitated and restless, and his memory was impaired, especially for recent events. The client displayed some delusions and misinterpretations of his surroundings. The nurse knows she needs to assess the client further for:
- A. Drug use.
- B. Infection.
- C. Metabolic disorder.
- D. None of the above.
Correct Answer: A
Rationale: The correct answer is A: Drug use. Given the client's sudden onset of symptoms, including altered mental status, agitation, memory impairment, delusions, and misinterpretations of surroundings, drug use is the most likely cause. Step 1: Consider the timeline - symptoms started within a few hours. Step 2: Review the symptoms - agitation, memory impairment, delusions, altered mental status. Step 3: Think of common causes for acute onset of these symptoms - drug use can lead to these manifestations. Step 4: Rule out other potential causes - infection and metabolic disorders typically present with different symptomatology and are less likely in this acute scenario. Step 5: Therefore, the nurse should prioritize assessing the client for drug use to provide appropriate interventions.