Age Specific Care Competency

Age Specific Care Competency Related

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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.

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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 are prominent, including emotional blunting which refers to a reduced ability to express emotions. This is commonly seen in clients with residual schizophrenia.

Explanation of why other choices are incorrect:
A: Bizarre, somatic delusions are characteristic of paranoid schizophrenia, not residual schizophrenia.
B: Disorganized speech pattern is a symptom of disorganized schizophrenia, not residual schizophrenia.
C: Catatonic posturing is associated with catatonic schizophrenia, not residual schizophrenia.

A nurse interviews a patient abducted and raped at gunpoint by an unknown assailant. The patient says, "I can't talk about it. Nothing happened. I have to forget." What is the patient's present coping strategy?

  • A. Somatization
  • B. Repression
  • C. Projection
  • D. Denial
Correct Answer: D

Rationale: The correct answer is D: Denial. The patient's statement of "I can't talk about it. Nothing happened. I have to forget" indicates a denial coping strategy. Denial is a defense mechanism where individuals refuse to acknowledge a stressful situation or event. In this case, the patient is attempting to block out the traumatic experience of being abducted and raped by denying its existence. This coping mechanism helps the individual temporarily avoid the emotional distress associated with the event.

A: Somatization involves expressing emotional distress through physical symptoms, which is not evident in the patient's statement.
B: Repression is the unconscious blocking of unpleasant memories, whereas the patient is consciously trying to forget the event.
C: Projection involves attributing one's own thoughts or feelings to others, which is not demonstrated in the patient's statement.

In summary, the patient's use of denial as a coping strategy is evident in their attempt to minimize the traumatic experience by refusing to acknowledge it.

A patient with severe dementia can no longer recognize her only daughter and becomes anxious and agitated when the daughter attempts to reorient her. An alternative the nurse could suggest to the daughter is to:

  • A. Wear a large name tag.
  • B. Visit her mother less often.
  • C. Talk about experiences they've shared.
  • D. None of the above.
Correct Answer: C

Rationale: The correct answer is C: Talk about experiences they've shared. This option is the most appropriate because reminiscing about past shared experiences can help trigger memories and emotions in the patient with dementia, potentially reducing anxiety and agitation. It can provide comfort and a sense of familiarity to the patient. Wearing a large name tag (option A) may not address the core issue of memory loss. Visiting less often (option B) could lead to further feelings of isolation and confusion for the patient. Option D, None of the above, is incorrect as option C provides a constructive and person-centered approach to improving the interaction between the patient and her daughter.

A couple in counseling reports fighting with their child when they are angry with each other. This behavior typifies:

  • A. coalition
  • B. indirect communication
  • C. transference
  • D. triangulation
Correct Answer: D

Rationale: Triangulation occurs when a third party (the child) is drawn into a conflict between two others, redirecting tension.

Marie is 16 years old. She has been referred to the clinic by the nurse at her school because she started a fight with a younger girl and hurt her badly. The school nurse reports that Marie has been troublesome beforeskipping school, bullying, and smoking on school grounds on several occasions. Of the following, which diagnosis is most likely?

  • A. Bipolar depression
  • B. Paranoid schizophrenia
  • C. Conduct disorder
  • D. Dysthymic disorder
Correct Answer: C

Rationale: Conduct disorder is characterized by a pattern of aggressive behavior and violating the rights of others, including defiance and rule breaking. The other responses are psychiatric disorders that would not be the most likely diagnosis given Maries behavior.

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