Age Specific Care Competency

Age Specific Care Competency Related

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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.

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The nurse is interviewing a client who presents with a dislocated shoulder. She demonstrates signs of anxiety and poor eye contact and turns to her partner for answers, allowing him to answer for her. Bruises on her breast and upper arm are visible. The nurse asks the partner to go to the admitting office to give insurance information. While the partner is out of the room, which question is most important to ask?

  • A. Have you been with your partner long?'
  • B. Have you ever been physically or emotionally hurt by someone?'
  • C. Are you an abused woman?'
  • D. Shall I notify the police that you would like to press charges?'
Correct Answer: B

Rationale: The correct answer is B: "Have you ever been physically or emotionally hurt by someone?" This question is important as it directly addresses the potential abuse the client may be experiencing. It allows the nurse to assess for any history of abuse, which could be contributing to the client's anxiety and behavior. It also opens up an opportunity for the client to disclose any abuse they may be facing.

Choice A is incorrect because the length of the relationship with the partner is not as crucial as addressing the potential abuse. Choice C is also incorrect because it is too direct and may not encourage the client to open up about their experiences. Choice D is incorrect as it assumes the client wants to press charges without first assessing the situation and the client's wishes.

A newly admitted patient diagnosed with paranoid schizophrenia is hypervigilant and constantly scans the environment. He states that he saw two doctors talking in the hall and knows they were plotting to kill him. When charting, how should the nurse identify this behavior?

  • A. Idea of reference
  • B. Delusion of infidelity
  • C. Auditory hallucination
  • D. Echolalia
Correct Answer: A

Rationale: The correct answer is A: Idea of reference. This patient's belief that the doctors were plotting to kill him is an example of an idea of reference, a symptom of paranoia common in paranoid schizophrenia. This term refers to the belief that neutral actions or events are directed at oneself. Delusion of infidelity (B) involves false beliefs about a partner's infidelity, not relevant here. Auditory hallucination (C) is false perception of sound, not applicable. Echolalia (D) is the repetition of words or phrases, not seen in this scenario. Identifying the behavior as an idea of reference helps the nurse understand the patient's distorted perception and tailor interventions effectively.

A common nursing diagnosis for a patient with antisocial personality disorder is:

  • A. chronic low self-esteem, related to poor self-image and excessive fear of failure
  • B. disturbed thought processes, related to sensory-perceptual alterations
  • C. impaired social interaction, related to manipulative behaviors
  • D. social isolation, related to anxiety in social situations
Correct Answer: C

Rationale: Impaired social interaction due to manipulation reflects the interpersonal challenges of antisocial personality disorder.

A patient who has been taking fluoxetine (Prozac) 60 mg daily for the past 6 months tells the nurse at the medication follow-up clinic that he is considering stopping the Prozac. He states his mood is fine, and now that he is living normally, his wife is concerned that he has no sex drive. Which response would be best?

  • A. Without the medicine the depression will likely return; you and your wife will need to adjust to the sexual side effects.
  • B. If we switch your medication time to the morning, the sexual side effects will be worn off in time for evening sexual activity.
  • C. The problem is not likely due to the medicine. Often the depression itself, even after it improves, continues to dampen sex drive.
  • D. Without an antidepressant, the depression is more likely to reoccur, but there are other medications that do not interfere so much with sex.
Correct Answer: D

Rationale: Step-by-step rationale for why answer D is correct:
1. Correctly acknowledges the patient's concern about sexual side effects.
2. Highlights the importance of managing depression to prevent recurrence.
3. Offers a solution by mentioning alternative medications with less impact on sex drive.
4. Empowers the patient by providing information and options for treatment.
5. Addresses both the patient's current situation and long-term mental health needs.

Summary of why other choices are incorrect:
A: Overlooks the patient's valid concern about sexual side effects and lacks a proactive solution.
B: Focuses on timing of medication without addressing the underlying issue of sexual side effects.
C: Dismisses the patient's concern and fails to provide a solution or alternative options.

Sensory experiences that occur in the absence of a stimulus are called

  • A. illusions
  • B. hallucinations
  • C. delusions
  • D. affect episodes
Correct Answer: B

Rationale: Hallucinations are perceptions without stimuli, distinct from illusions (misinterpretations).

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