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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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What would be an expected outcome for a patient with anorexia nervosa undergoing treatment?
- A. The patient will stabilize weight at a normal level.
- B. The patient will participate in group therapy regularly.
- C. The patient will express satisfaction with their body image.
- D. The patient will regain full cognitive function and independence.
Correct Answer: A
Rationale: The correct answer is A. In Anorexia Nervosa treatment, the primary goal is weight restoration to a healthy level. This is crucial for physical health and recovery. Stabilizing weight at a normal level is a key indicator of treatment success. Choices B, C, and D are incorrect as they do not address the core issue of weight restoration, which is essential in treating Anorexia Nervosa. Group therapy, body image satisfaction, and cognitive function are important aspects of treatment but not the primary outcome measure for patients with anorexia nervosa.
The client has been taking lithium and fluoxetine (Prozac) for almost a week. During today's assessment, the nurse notes a temperature of 39°C, muscle rigidity, and confusion. The client's signs and symptoms suggest:
- A. Dystonic reactions
- B. Bradykinesic side effects
- C. Extrapyramidal side effects
- D. Neuroleptic malignant syndrome
Correct Answer: D
Rationale: The correct answer is D: Neuroleptic malignant syndrome (NMS). This is indicated by the client's elevated temperature, muscle rigidity, and confusion, which are classic symptoms of NMS. NMS is a serious, potentially life-threatening condition associated with the use of antipsychotic medications like lithium and fluoxetine. The onset of NMS is often rapid and can lead to severe complications if not treated promptly. Dystonic reactions (choice A) involve sudden and involuntary muscle contractions, which are not consistent with the client's symptoms. Bradykinesic side effects (choice B) refer to slowed movements, which are not present in this case. Extrapyramidal side effects (choice C) typically include symptoms like tremors, stiffness, and restlessness, but do not encompass the combination of symptoms seen in NMS.
A young patient diagnosed with schizophrenia is standing naked after showering and appears to be both dazed and indecisive. The nursing intervention that will be most helpful to promote dressing would be:
- A. saying, 'These are your clothes. Please get dressed.'
- B. saying, 'These are your underpants. I'll help you put them on.'
- C. asking, 'Which of these two outfits would you like to wear now?'
- D. asking, 'Is something the matter with your clothes that makes you not want to dress?'
Correct Answer: B
Rationale: The correct answer is B. By saying, "These are your underpants. I'll help you put them on," the nurse provides clear guidance and offers assistance, which can help the patient feel more comfortable and supported in the dressing process. This approach acknowledges the patient's need for help while respecting their autonomy.
Choice A is too directive and may make the patient feel pressured or overwhelmed. Choice C involves too many options, which can be confusing for a patient experiencing indecisiveness. Choice D assumes a problem with the clothes rather than focusing on the patient's needs and feelings. Overall, choice B is the most appropriate and supportive intervention in this situation.
In DSM-IV-TR intellectual disabilities are divided into a number of degrees of severity, depending primarily on the range of IQ score provided by the sufferer. One of these is Moderate Mental Retardation, represented by an IQ score between:
- A. 60-65 - to 70-75
- B. 35-40 to 50-55
- C. 80-85 to 90-95
- D. 20-25 to 30-35
Correct Answer: B
Rationale: Moderate Mental Retardation: Defined by DSM-IV-TR as an IQ score between 35-40 to 50-55.
A client who is diagnosed with schizoid personality disorder is isolative, does not speak to her peers, and sits through the community meeting without speaking. Her mother describes her as shy and having few friends. Which would be an appropriate nursing diagnosis for this client?
- A. Anxiety related to a new environment as evidenced by isolation and not talking with peers
- B. Impaired social interaction related to unfamiliar environment as evidenced by isolation and not talking with peers
- C. Ineffective coping related to new environment as evidenced by isolation and minimal interaction with others
- D. Disturbed thought processes related to a new environment as evidenced by isolation and minimal interactions with others
Correct Answer: B
Rationale: The correct answer is B: Impaired social interaction related to unfamiliar environment as evidenced by isolation and not talking with peers. This is the most appropriate nursing diagnosis because schizoid personality disorder is characterized by a pattern of social detachment and limited emotional expression. The client's behavior of isolating herself and not engaging with peers aligns with impaired social interaction.
Choice A (Anxiety) is incorrect because the client's behavior is more indicative of social detachment rather than anxiety. Choice C (Ineffective coping) is incorrect as there is no evidence to suggest the client is using maladaptive coping strategies. Choice D (Disturbed thought processes) is incorrect as the client's presentation does not indicate any disturbances in thought processes, but rather a lack of social engagement.