Age Specific Nursing Care

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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.

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In the OB follow-up clinic, your patient, who is 4 weeks post-delivery, tells you she is sleeping for long hours, wants to avoid taking care of the baby, and wishes she had never had the baby. What would be your first response?

  • A. Its normal to feel overwhelmed at first.
  • B. Tell me more about these feelings.
  • C. Report her to Child Protective Services.
  • D. Ill call your husband right away to get you back home to rest.
Correct Answer: B

Rationale: The open-ended question (B) will give you more information and be less judgmental to this patient. This behavior is not normal at 4 weeks post-delivery and more rest is probably not adequate treatment. You would like a lot more information before reporting this as neglect.

A boy with a conduct disorder diagnosis would be most likely to have which symptom?

  • A. Withdrawal
  • B. Ritualistic behavior
  • C. Class bully
  • D. Class clown
Correct Answer: C

Rationale: A pattern of bullying is a common sign of conduct disorder. Responses A and B may reflect autism.

Hearing voices that are not really there would be called a(n)

  • A. hallucination
  • B. delusion
  • C. auditory regression
  • D. depressive psychosis
Correct Answer: A

Rationale: Hallucinations involve perceiving stimuli (e.g., voices) that aren't present, unlike delusions (beliefs).

When assessing the elderly for depression, the nurse may find that a depressed person over 70 years of age without a medical diagnosis, may have the following symptoms of depression (Select one tha does not apply):

  • A. Aches
  • B. Pains
  • C. Constipation
  • D. One-sided weakness
Correct Answer: D

Rationale: These symptoms (A, B, C, E) can be confused with other conditions like electrolyte imbalance or dementia, but are common physical manifestations of depression in the elderly. One-sided weakness (D) is more specific to stroke, not depression.

The nurse is administering haloperidol (Haldol) to a client experiencing delusions and hallucinations associated with schizophrenia. The nurse can expect symptom abatement as a result of the drug's action to:

  • A. Reduce the number of brain cells that crave dopamine
  • B. Block dopamine receptors, making dopamine less available
  • C. Enhance dopamine receptors, making more dopamine available
  • D. Cause increased cellular production of dopamine
Correct Answer: B

Rationale: The correct answer is B because haloperidol is a typical antipsychotic that works by blocking dopamine receptors in the brain. By blocking these receptors, haloperidol reduces the effects of excess dopamine, which is known to contribute to symptoms of schizophrenia such as delusions and hallucinations. This action helps alleviate the positive symptoms of schizophrenia.

Choice A is incorrect because haloperidol does not reduce the number of brain cells that crave dopamine; it acts on the receptors themselves. Choice C is incorrect because enhancing dopamine receptors would lead to an increase in the effects of dopamine, worsening symptoms. Choice D is incorrect because haloperidol does not cause increased cellular production of dopamine; it blocks dopamine receptors instead.

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