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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 nurse is anxious about assessing the sexual history of a patient who is considerably older than the nurse is. Which statement would be most appropriate for obtaining information about the patient's sexual practices?
- A. Some people are not sexually active, others have a partner, and some have several partners. What has been your pattern?
- B. Sexual health can reflect a number of medical problems, so I'd like to ask if you have any sexual problems you think we should know about.
- C. It's your own business, of course, but it might be helpful for us to have some information about your sexual history. Could you tell me about that, please?
- D. I would appreciate it if you could share your sexual history with me so I can share it with your health care provider. It might be helpful in planning your treatment.
Correct Answer: A
Rationale: The correct answer is A because it acknowledges the diversity of sexual practices and respects the patient's autonomy in sharing their sexual history. It also allows the patient to openly discuss their pattern without feeling pressured.
Choice B is incorrect because it focuses on potential medical problems rather than directly asking about the patient's sexual practices.
Choice C is incorrect as it may come across as too intrusive and lacks a non-judgmental approach.
Choice D is incorrect as it implies the patient's information will be shared without their consent, which violates patient confidentiality.
The nurse caring for a school-age child who has been sexually abused by a close family member realizes that the child may resist disclosing the experience of being sexually abused because the child:
- A. Realizes that repeated questioning by others will occur
- B. Fears being blamed or disbelieved
- C. Fears becoming an object of pity at school
- D. Is embarrassed about facing family members
Correct Answer: B
Rationale: The correct answer is B: Fears being blamed or disbelieved. This is because children who have been sexually abused often fear that they will not be believed or may be blamed for what happened. This fear can prevent them from disclosing the abuse. Choice A is incorrect because repeated questioning may not be the primary reason for the child's resistance. Choice C is incorrect because the child's fear of being pitied at school is not typically a main concern when disclosing sexual abuse. Choice D is incorrect because embarrassment about facing family members may be a factor, but the fear of blame or disbelief is usually a more significant barrier to disclosure in cases of sexual abuse.
The client has become unable to recognize formerly familiar objects and people in his environment. The client is experiencing:
- A. Affect "“ experienced feelings and emotions
- B. Agnosis "“ inability to recognize familiar objects or people
- C. Apraxia "“ difficulty carrying out purposeful, organized task that is somewhat complex (ex. dressing)
- D. Anhedonia "“ lack of pleasure
Correct Answer: B
Rationale: The correct answer is B: Agnosis - inability to recognize familiar objects or people. This is because the client's inability to recognize formerly familiar objects and people in his environment aligns with the definition of agnosis. Affect (choice A) refers to experienced feelings and emotions, which is not the issue described in the question. Apraxia (choice C) is difficulty carrying out purposeful tasks, not related to recognition of objects or people. Anhedonia (choice D) is a lack of pleasure, which is also not applicable to the client's situation. Therefore, the best fit for the client's experience is agnosis.
A client with obsessive-compulsive personality disorder seeks treatment for depression after the recent breakup of a relationship. The client constantly procrastinated about proposing marriage and said his girlfriend complained that he did not show her affection and that he was too controlling. Now he describes inability to sleep, poor concentration, and loss of energy since the breakup. Which outcome is a priority for the client? The client will:
- A. Demonstrate assertive behavior
- B. Express hope for developing a new relationship in the future
- C. Identify feelings of sadness related to the failed relationship
- D. List three new ways to reduce stress
Correct Answer: C
Rationale: Rationale: The correct answer is C: Identify feelings of sadness related to the failed relationship. This is the priority outcome because the client is experiencing symptoms of depression following the breakup, such as insomnia, poor concentration, and loss of energy. By identifying and processing the feelings of sadness related to the failed relationship, the client can begin to work through the grief and start the healing process.
Summary:
A: Demonstrating assertive behavior may be beneficial for the client in the long term but is not the priority at this stage when dealing with depression.
B: Expressing hope for a new relationship may provide temporary relief but does not address the underlying issues of depression and unresolved feelings from the breakup.
D: Listing new ways to reduce stress is important for overall well-being but does not address the primary concern of processing feelings of sadness and grief related to the failed relationship.
Which intervention would be the best initial approach for a nurse to take when a young adult patient is verbally abusive?
- A. Ask the patient to define 'verbally abusive language.'
- B. Provide the patient with examples of assertive communication.
- C. Identify the patient's verbal abuse in order to set standards for future dialogue.
- D. Remove privileges from the patient until communications show less aggression.
Correct Answer: C
Rationale: The correct initial approach is to identify the patient's verbal abuse to set standards for future dialogue. This approach addresses the behavior directly, establishes boundaries, and communicates expectations for respectful communication. Asking the patient to define 'verbally abusive language' (choice A) may not effectively address the current behavior. Providing examples of assertive communication (choice B) may not directly address the abusive behavior. Removing privileges (choice D) may escalate the situation and is not a constructive communication strategy. By identifying the patient's verbal abuse, the nurse can address the behavior effectively and work towards a respectful and therapeutic relationship.