Nokea
A patient states that unit staff members have been avoiding them since an attempt to self-mutilate. The psychiatric-mental health nurse's most appropriate response is to:
- A. apologize for the staff's behavior
- B. explain that feelings of rejection are typical after self-mutilation
- C. listen, redirect the patient to their feelings, and explore the issue with the staff
- D. report the matter to the nurse manager
Correct Answer: C
Rationale: Listening validates the patient, redirecting focuses on their emotions, and exploring with staff addresses care quality.
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A woman tells the nurse, 'My partner is frustrated with me. I don't have any natural lubrication when we have sex.' What type of sexual disorder is evident?
- A. Genito-pelvic pain/penetration disorder
- B. Female sexual interest/arousal disorder
- C. Hypoactive sexual desire disorder
- D. Female orgasmic disorder
Correct Answer: B
Rationale: The correct answer is B: Female sexual interest/arousal disorder. The woman's complaint of lack of natural lubrication during sex indicates a difficulty in arousal, which falls under this disorder category. This is because arousal difficulties can lead to inadequate lubrication, impacting sexual satisfaction. Genito-pelvic pain/penetration disorder (A) involves pain during intercourse, not lack of lubrication. Hypoactive sexual desire disorder (C) refers to low libido, not lubrication issues. Female orgasmic disorder (D) pertains to difficulties reaching orgasm, not lubrication problems.
A patient with bipolar disorder, mania, relapsed after discontinuing lithium. The health care provider prescribes lithium 600 mg BID and olanzapine (Zyprexa) 10 mg BID. What is the rationale for addition of olanzapine to the lithium regime? It will:
- A. Minimize the side effects of lithium.
- B. Bring hyperactivity under rapid control.
- C. Potentiate the antimanic action of lithium.
- D. Be used for long-term control of hyperactivity.
Correct Answer: B
Rationale: The correct answer is B: Bring hyperactivity under rapid control.
Rationale:
1. Olanzapine is an atypical antipsychotic known for its rapid onset of action in controlling manic symptoms, including hyperactivity.
2. Lithium alone may take time to reach therapeutic levels and show efficacy, while olanzapine can provide more immediate relief.
3. Combining olanzapine with lithium can address acute manic symptoms effectively and quickly.
4. Choice A is incorrect because olanzapine does not specifically minimize lithium's side effects.
5. Choice C is incorrect as olanzapine does not directly potentiate lithium's antimanic action.
6. Choice D is incorrect because olanzapine is typically used for acute symptom management rather than long-term control.
Because there is considerable overlap among the types of schizophrenia, and because patterns of behavior shift over time, many patients are simply classified as suffering from schizophrenia
- A. borderline
- B. atypical
- C. mixed
- D. undifferentiated
Correct Answer: D
Rationale: Undifferentiated schizophrenia is diagnosed when symptoms don't clearly fit other subtypes, reflecting overlap and shifting patterns.
A 14-year-old female comes into clinic for a medical certificate once a week for multiple complaints of chest pain and abdominal pain. The complaints are non-specific, and her physical examination is normal. She is quiet with poor eye contact. She states the pain is worse on school days. Her mother is concerned that her daughter is being bullied but won't talk to her. Her mother is also worried that her complaints represent an undiagnosed medical condition. The next best step in management is:
- A. Referral to tertiary hospital to rule out organic cause
- B. HEADSS or other psychosocial screening
- C. Referral for counselling
- D. Reassurance that nothing is wrong
Correct Answer: B
Rationale: HEADSS screening assesses psychosocial factors (e.g., bullying, stress) that may underlie somatic complaints, making it the best next step before referral or reassurance.
A man, aged 84 years, was stopped for going through a red light in a small town where he lives. He told the officer, 'It wasn't there yesterday.' He was unable to tell the officer his address and demonstrated labile mood, seeming pleasant one minute and angry the next. The officer took the man home to discuss his condition with the family and found that he has been wandering around the neighborhood, sometimes taking tools from people's garages, saying they belong to him. The family reluctantly agreed that he should go to the emergency department. What cardinal sign of Alzheimer's disease does this patient demonstrate?
- A. Agnosia.
- B. Apraxia.
- C. Aphasia.
- D. None of the above.
Correct Answer: A
Rationale: The correct answer is A: Agnosia. Agnosia is the inability to recognize or interpret sensory information, such as objects, people, sounds, or shapes. In this case, the patient's inability to recognize the red light, his own address, and the ownership of tools indicates a problem with perception and recognition. This aligns with the symptoms of agnosia commonly seen in Alzheimer's disease.
Choices B and C are incorrect. Apraxia is the inability to perform purposeful movements, and aphasia is the loss of ability to understand or express speech. These symptoms are not the primary cardinal sign demonstrated by the patient in the scenario. Choice D, "None of the above," is also incorrect as the patient's symptoms align with the characteristics of agnosia.