Age Specific Care Competency

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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 that is effective in treating both positive and negative symptoms of schizophrenia. It also has a lower risk of causing extrapyramidal symptoms like muscle stiffness and motor restlessness compared to typical antipsychotics like haloperidol. Chlorpromazine (A) is a typical antipsychotic with similar side effects as haloperidol. Clozapine (B) is an atypical antipsychotic that is effective for treatment-resistant schizophrenia but is usually considered as a last resort due to its potential for serious side effects. Fluoxetine (D) is an antidepressant and not typically used as a first-line treatment for schizophrenia.

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A patient's body is covered by fine, downy hair. The patient weighs 70 pounds and is 5 feet 4 inches tall. Which term should be documented?

  • A. Amenorrhea
  • B. Alopecia
  • C. Lanugo
  • D. Stupor
Correct Answer: C

Rationale: The correct term to be documented is C: Lanugo. Lanugo is fine, downy hair that can cover a patient's body, often seen in newborns or individuals with certain medical conditions. In this case, the presence of lanugo indicates a potential underlying issue. Amenorrhea (A) refers to the absence of menstruation, not related to the hair. Alopecia (B) is hair loss, the opposite of lanugo. Stupor (D) is a state of reduced consciousness, not related to the hair condition described. Therefore, choice C is the correct answer as it directly matches the description given in the question.

The chief distinguishing feature of psychotic disorders is

  • A. confusion of fantasy and reality
  • B. antisocial conduct
  • C. overwhelming anxiety
  • D. obsessive behavior
Correct Answer: A

Rationale: Psychotic disorders are characterized by a loss of reality testing, such as hallucinations and delusions, distinguishing them from other conditions.

The first step in the treatment of sleep disorders is to:

  • A. Teach prevention.
  • B. Give hypnotics for sleep.
  • C. Evaluate sleeping patterns.
  • D. None of the above.
Correct Answer: C

Rationale: The correct answer is C: Evaluate sleeping patterns. This is the first step in treating sleep disorders because it helps identify the underlying causes and specific nature of the disorder. By understanding the patterns, triggers, and behaviors related to sleep, healthcare providers can tailor effective treatment plans. Choice A (Teach prevention) is incorrect as evaluation comes before prevention strategies. Choice B (Give hypnotics for sleep) is incorrect as medication should be considered only after thorough evaluation. Choice D (None of the above) is incorrect as evaluating sleeping patterns is crucial for effective treatment.

A novice nurse tells the assigned mentor, 'I admitted a patient today who has several bizarre delusions. I wanted to tell the patient that the ideas and conclusions simply are not logical. What do you think will happen if I do?' Which reply by the mentor is best?

  • A. I think you'll give the patient something to think about.'
  • B. The patient will probably incorporate you into the delusions as a persecutor.'
  • C. Develop trust using empathy and calmness before pointing out discrepancies.'
  • D. Initially, it would be better to go along with the patient's thinking to gain cooperation.'
Correct Answer: C

Rationale: The correct answer is C because it emphasizes the importance of developing trust and rapport with the patient before addressing their delusions. By using empathy and calmness, the nurse can create a safe environment for the patient to feel understood and supported. This approach can help the patient be more receptive to feedback about the discrepancies in their thinking.

Choice A is incorrect because simply giving the patient something to think about may not address the underlying issues causing the delusions.

Choice B is incorrect as it assumes the patient will view the nurse negatively, which may not always be the case.

Choice D is incorrect as it suggests going along with the patient's delusions, which can potentially reinforce and perpetuate their false beliefs.

A client with a borderline personality disorder tells the nurse, 'My doctor tells me there's something wrong with the hard wiring of my brain, and that's why I'm so impulsive and get so many mood swings. He said he's going to prescribe some medication.' Being aware of current practice guidelines, the nurse will prepare a teaching plan for:

  • A. Lithium
  • B. Fluoxetine
  • C. Lorazepam
  • D. Haloperidol
Correct Answer: B

Rationale: The correct answer is B: Fluoxetine. In the context of borderline personality disorder, fluoxetine, a selective serotonin reuptake inhibitor (SSRI), is often used to manage symptoms such as mood swings and impulsivity. SSRIs help regulate serotonin levels in the brain, which can improve mood stability and reduce impulsive behaviors.

- A: Lithium is typically used for bipolar disorder, not borderline personality disorder.
- C: Lorazepam is a benzodiazepine used for anxiety or panic disorders, not specific to treating symptoms of borderline personality disorder.
- D: Haloperidol is an antipsychotic medication used for psychosis, not typically indicated for managing impulsivity or mood swings in borderline personality disorder.

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