Population Based Care

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A patient received maintenance doses of fluphenazine decanoate (Prolixin Decanoate) 25 mg IM every 2 weeks for 2 years. The clinic nurse notes the patient is grimacing and seems to be constantly smacking her lips. On the next clinic visit, the patient's neck and shoulders twist in a slow, snakelike motion. The nurse should suspect the presence of ______ and should ______.

  • A. agranulocytosis"¦check the patient's complete blood count for changes
  • B. tardive dyskinesia"¦administer the Abnormal Involuntary Movement Scale
  • C. Tourette's syndrome"¦consult the patient's physician about a neuro evaluation
  • D. anticholinergic effects"¦consult the physician about possible medication changes
Correct Answer: B

Rationale: Step 1: The patient is showing signs of abnormal movements like lip smacking, grimacing, and snakelike motions, which are indicative of tardive dyskinesia (TD).
Step 2: TD is a side effect of long-term antipsychotic use, such as fluphenazine decanoate.
Step 3: The Abnormal Involuntary Movement Scale is a validated tool to assess the severity of TD.
Step 4: Administering the Abnormal Involuntary Movement Scale will help confirm the diagnosis of TD.
Step 5: Prompt recognition of TD is crucial as it may be irreversible and can worsen over time if not addressed.

Summary:
- A: Agranulocytosis is a condition characterized by low white blood cell count, not related to the patient's symptoms.
- C: Tourette's syndrome presents with different symptoms and requires specialized evaluation.
- D: Anticholinergic effects do not typically manifest as the described

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A patient diagnosed with schizophrenia has difficulty completing tasks and seems forgetful and disinterested in unit activities. A nurse can best select successful strategies by understanding that these behaviors are due to:

  • A. a lack of self-esteem.
  • B. manipulative tendencies.
  • C. shyness and embarrassment.
  • D. problems in cognitive functioning.
Correct Answer: D

Rationale: The correct answer is D: problems in cognitive functioning. In schizophrenia, cognitive deficits are common, leading to difficulties in completing tasks, forgetfulness, and lack of interest. Understanding this helps the nurse select appropriate strategies, such as breaking tasks into smaller steps. Choice A (lack of self-esteem) is incorrect as cognitive deficits in schizophrenia are not solely related to self-esteem. Choice B (manipulative tendencies) is incorrect as these behaviors are not indicative of manipulation. Choice C (shyness and embarrassment) is incorrect as cognitive deficits in schizophrenia go beyond social anxiety.

A client who has been diagnosed as having bulimia nervosa is hospitalized for treatment of electrolyte imbalance. Just before lunch is finished, the client leaves the table and walks quickly in the direction of the bathroom. The nurse should say:

  • A. No one is allowed to leave the dining room during meals.'
  • B. I must accompany you when you go to the bathroom.'
  • C. I think I understand your plan, and I cannot permit you to carry it out.'
  • D. Wouldn't it be preferable to exercise rather than vomit?'
Correct Answer: B

Rationale: The correct answer is B because accompanying the client to the bathroom is essential to prevent purging behavior associated with bulimia nervosa. By doing so, the nurse can provide support, monitor the client, and intervene if necessary to ensure the client's safety. Choice A is incorrect as it may come across as punitive and restrictive. Choice C is incorrect as it may escalate the situation and lead to confrontation. Choice D is incorrect as it suggests an alternative behavior without addressing the immediate concern of potential purging. Accompanying the client to the bathroom is the most appropriate and therapeutic response in this situation.

The distinction between obsessions and compulsions is the distinction between

  • A. engaging in behaviors that are merely inconvenient and those that are severely disruptive
  • B. having positive and negative feelings toward an object or event
  • C. thoughts that are evidence of neurosis or those that are evidence of psychosis
  • D. having repetitious thoughts or engaging in repetitious actions
Correct Answer: D

Rationale: Obsessions are intrusive thoughts, while compulsions are repetitive actions to relieve them.

The nurse is caring for a client who is being treated for comorbid eating or affective disorder. For which medication would the nurse expect to prepare a client teaching plan?

  • A. Fluoxetine (Prozac).
  • B. Diazepam (Valium).
  • C. Lorazepam (Ativan).
  • D. Lithium.
Correct Answer: A

Rationale: The correct answer is A: Fluoxetine (Prozac). Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) commonly used to treat eating disorders and affective disorders like depression. The nurse would prepare a client teaching plan for fluoxetine to educate the client on its mechanism of action, potential side effects, proper dosing, and the importance of compliance. Diazepam and lorazepam are benzodiazepines used for anxiety and not typically indicated for eating or affective disorders. Lithium is primarily used for bipolar disorder and not specifically for eating or affective disorders.

A homeless individual diagnosed with serious mental illness, anosognosia, and a history of persistent treatment nonadherence is persuaded to come to the day program at a community mental health center. Which intervention should be the teams initial focus?

  • A. Teach appropriate health maintenance and prevention practices.
  • B. Educate the patient about the importance of treatment adherence.
  • C. Help the patient obtain employment in a local sheltered workshop.
  • D. Interact regularly and supportively without trying to change the patient.
Correct Answer: D

Rationale: Building trust through regular, supportive interaction (D) is the initial focus to address nonadherence and anosognosia, forming a foundation for later interventions (A, B, C).

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