Age Specific Patient Care

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A patient receiving risperidone (Risperdal) reports severe muscle stiffness midmorning. During lunch he has difficulty swallowing food and speaking, and when vital signs are taken 30 minutes later, he is noted to be stuporous and diaphoretic, with a temperature of 38.8° C, pulse of 110 beats/min, and blood pressure of 150/90 mm Hg. The nurse should suspect _____ and should _____.

  • A. neuroleptic malignant syndrome"¦place him in a cooling blanket and transfer to ICU
  • B. anticholinergic toxicity"¦check vital signs and prepare to use a cooling blanket stat
  • C. relapse of his psychosis"¦administer PRN antipsychotic drugs and notify his physician
  • D. agranulocytosis"¦hold his antipsychotic and draw blood for a complete blood count
Correct Answer: A

Rationale: The correct answer is A: neuroleptic malignant syndrome (NMS). NMS is a rare but serious adverse reaction to antipsychotic medications like risperidone. The patient's symptoms of severe muscle stiffness, difficulty swallowing, altered mental status, diaphoresis, and elevated temperature, pulse, and blood pressure are all consistent with NMS. The nurse should suspect NMS due to the constellation of symptoms and vital sign changes. Placing the patient in a cooling blanket and transferring to the ICU is appropriate as NMS is a medical emergency requiring prompt intervention to lower the body temperature and provide supportive care.

Choices B, C, and D are incorrect:
B: Anticholinergic toxicity does not typically present with the specific symptoms described, such as muscle stiffness and stupor.
C: Relapse of psychosis would not explain the acute onset of symptoms and vital sign changes seen in the scenario.
D: Agranulocytosis is a rare side effect of some ant

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Fragile X syndrome is associated with which of the following?

  • A. Language impairment
  • B. Behavioural problems
  • C. Moderate levels of intellectual disability
  • D. All of the above
Correct Answer: D

Rationale: Fragile X Syndrome: A chromosomal abnormality causing intellectual disability, language impairment, and behavioral issues.

A person diagnosed with serious mental illness has frequent relapses, usually precipitated by situational stressors such as running out of money or the absence of key staff at the mental health center. Which interventions would the nurse suggest to reduce the risk of stressors to cause relapse? Select one tha does not apply.

  • A. Discourage potentially stressful activities such as groups or volunteer work
  • B. Develop written plans that will help the patient remember what to do in a crisis
  • C. Help the patient identify and anticipate events that are likely to be overwhelming
  • D. Encourage health-promoting activities such as exercise and getting adequate rest
Correct Answer: A

Rationale: Basic interventions for coping with crises involve anticipating crises where possible and then developing a plan with specific actions to take when faced with an overwhelming stressor. Written plans are helpful; it can be difficult for anyone, especially a person with cognitive or memory impairments, to develop or remember steps to take when under overwhelming stress. Health-promoting activities enhance a persons ability to cope with stress. As the name suggests, support groups help a person develop a support system, and they provide practical guidance from peers who learned from experience how to deal with issues the patient may be facing. Groups and volunteer work may involve a measure of stress but also provide benefits that help persons cope and should not be discouraged unless they are being done to excess.

A community mental health nurse receives a new client for his caseload. The diagnosis of the client is residual schizophrenia. Documentation states that the client has a number of negative symptoms. Which symptom would the nurse expect to assess in the client?

  • A. Bizarre, somatic delusions
  • B. Disorganized speech pattern
  • C. Catatonic posturing
  • D. Emotional blunting
Correct Answer: D

Rationale: The correct answer is D: Emotional blunting. In residual schizophrenia, negative symptoms involve deficits in normal emotional responses and behaviors. Emotional blunting refers to a reduction in the intensity of emotional expression, which is commonly seen in clients with residual schizophrenia. This symptom can include a lack of facial expressions, reduced vocal inflections, and overall flat affect.

Choice A (Bizarre, somatic delusions) is incorrect as it refers to a positive symptom of schizophrenia involving distorted beliefs about the body.

Choice B (Disorganized speech pattern) is incorrect as it is characteristic of disorganized schizophrenia, not residual schizophrenia.

Choice C (Catatonic posturing) is incorrect as it is a symptom of catatonic schizophrenia, not residual schizophrenia.

A nursing diagnosis for a patient with bulimia nervosa is Ineffective coping related to feelings of loneliness and isolation, as evidenced by use of overeating and self-induced vomiting to comfort self. Select the best outcome related to this diagnosis. Within 2 weeks, the patient will:

  • A. Appropriately express angry feelings.
  • B. Verbalize two positive things about self.
  • C. Verbalize the importance of eating a balanced diet.
  • D. None of the above.
Correct Answer: D

Rationale: Rationale:
1. Patient's diagnosis indicates coping issues, not anger expression or self-esteem.
2. Patient's coping mechanism involves overeating and vomiting, not diet.
3. Outcome should focus on coping skills improvement, not unrelated goals.
4. None of the choices address the root issue of coping with loneliness and isolation.
5. Thus, the correct answer is D, as none of the options directly address the patient's ineffective coping mechanism.

The nurse is evaluating a patient with bulimia nervosa. The most appropriate action is to:

  • A. Assign a strict dietary plan to prevent weight gain.
  • B. Monitor the patient for physical symptoms of starvation.
  • C. Encourage the patient to avoid purging after meals.
  • D. Provide emotional support without focusing on food-related behaviors.
Correct Answer: C

Rationale: The correct answer is C: Encourage the patient to avoid purging after meals. This is the most appropriate action because it addresses the harmful purging behavior associated with bulimia nervosa. By encouraging the patient to avoid purging, the nurse can help prevent serious health consequences such as electrolyte imbalances and damage to the esophagus.

Option A is incorrect because assigning a strict dietary plan may exacerbate the patient's unhealthy relationship with food and contribute to feelings of guilt and shame. Option B is incorrect as monitoring for physical symptoms of starvation may not directly address the underlying issue of purging behavior. Option D is also incorrect as providing emotional support alone may not effectively address the harmful purging behavior.

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