Population Based Health Care

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A patient with many positive symptoms of schizophrenia, whose behavior is disorganized and who is highly anxious, tells the nurse in the psychiatric emergency department, 'You have got to help me. I do not know what is going on. I think someone is trying to wipe me out. I have to get a gun.' The patient, a college student, lives alone and has no family or support system in the immediate area. He has not left his room in 2 weeks, has not eaten in several days, and is unkempt. Of the available treatment settings, the nurse should recommend:

  • A. admission to an unlocked residential crisis unit.
  • B. inpatient hospitalization on a locked unit.
  • C. attending a day treatment program for 4 weeks.
  • D. admission to a partial hospital program.
Correct Answer: B

Rationale: The correct answer is B: inpatient hospitalization on a locked unit. This option is the most appropriate because the patient is presenting with severe symptoms of schizophrenia, including paranoia, disorganized behavior, and potential harm to self or others by mentioning getting a gun. In this case, the patient requires a higher level of care and safety, which can only be provided in an inpatient hospital setting on a locked unit. Admission to an unlocked residential crisis unit (Choice A) may not provide the necessary level of supervision and security. Attending a day treatment program for 4 weeks (Choice C) may not be intensive enough to address the patient's current crisis. Admission to a partial hospital program (Choice D) also may not provide the required level of supervision and structure for a patient with such acute symptoms.

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When coping with a patient's inappropriate expression of anger, a psychiatric-mental health nurse's initial action is to identify the:

  • A. appropriate limit-setting techniques
  • B. nurse's own response to the anger
  • C. patient's specific defense mechanisms
  • D. systems theory for effecting change
Correct Answer: B

Rationale: Understanding the nurse's own emotional response ensures objectivity and effective management of the patient's anger.

An elderly patient must be physically restrained. Who is responsible for the patient's safety?

  • A. The nurse assigned to care for the patient
  • B. Unlicensed assistive personnel who apply the restraint
  • C. Family member who agrees to application of the restraint
  • D. Health care provider who prescribed application of restraint
Correct Answer: A

Rationale: The correct answer is A: The nurse assigned to care for the patient. The nurse is responsible for the patient's safety because they are the primary caregiver and have the training and knowledge to ensure proper application of restraints, monitor the patient's condition, and respond to any potential complications. Unlicensed assistive personnel (choice B) may apply restraints under the nurse's supervision but do not have the same level of training or accountability. Family members (choice C) and healthcare providers (choice D) may be involved in the decision-making process, but ultimate responsibility for patient safety lies with the nurse who directly cares for the patient.

Anorexia nervosa is best described as a disorder that is potentially:

  • A. serious.
  • B. uncommon.
  • C. psychiatric.
  • D. life threatening.
Correct Answer: D

Rationale: The correct answer is D: life threatening. Anorexia nervosa is a serious eating disorder characterized by extreme restriction of food intake, leading to significant weight loss and potentially life-threatening consequences such as organ damage, heart problems, and even death. It is crucial to recognize the severity of anorexia nervosa as it can have devastating effects on physical and mental health. Choices A and C are partially correct, as anorexia nervosa is serious and psychiatric, but they do not fully capture the potential severity and life-threatening nature of the disorder. Choice B is incorrect as anorexia nervosa is not uncommon, affecting a significant number of individuals worldwide.

The wife of a patient with schizophrenia is worried about her 17-year-old daughter and asks the nurse what symptoms mark the prodromal stage of schizophrenia. The nurse should respond by listing behaviors such as:

  • A. withdrawal, poor concentration, phobic or obsessive behavior, oddities of speech.
  • B. auditory hallucinations, ideas of reference, thought insertion, and broadcasting.
  • C. stereotyped behavior, echopraxia, echolalia, waxy flexibility, thought-blocking.
  • D. looseness of associations, concrete thinking, echolalia, paranoid delusions.
Correct Answer: A

Rationale: The correct answer is A because the symptoms listed: withdrawal, poor concentration, phobic or obsessive behavior, and oddities of speech are characteristic of the prodromal stage of schizophrenia. During this phase, individuals may start to exhibit subtle changes in behavior and thinking, which may signal the onset of the disorder.

Choice B includes symptoms of active psychosis, such as auditory hallucinations and delusions, which are not typically seen in the prodromal stage. Choice C describes symptoms of catatonia, which are not specific to the prodromal phase. Choice D includes symptoms of acute psychosis, such as paranoid delusions, which are not typically present during the prodromal stage.

In summary, the correct answer is A because it accurately reflects the early, subtle symptoms that may precede the full onset of schizophrenia, while the other choices describe symptoms that are more indicative of later stages of the disorder.

One bed is available on the eating disorders unit. Which patient should be admitted? The patient whose assessment findings show the weight dropped from:

  • A. 150 to 102 pounds over a 4-month period.
  • B. 120 to 90 pounds over a 3-month period.
  • C. 130 to 100 pounds over a 2-month period.
  • D. None of the above.
Correct Answer: A

Rationale: The correct answer is A because the patient has experienced a significant weight drop from 150 to 102 pounds over a 4-month period. This represents a loss of 48 pounds over a relatively longer period, indicating a more severe and prolonged issue with weight loss. The other choices show weight drops of 30 pounds over 3 months (B) and 30 pounds over 2 months (C), which are also concerning but not as severe or long-lasting as the situation described in choice A. Choice D is incorrect as at least one patient should be admitted based on the information provided.

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