Population Based Care

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A patient with schizophrenia has been stabilized in the Crisis Center and is about to be discharged. He will be living with his family, but the family knows nothing about the patient's illness, its treatment, or the role they can play in his recovery. Which activity would be most beneficial for the family to attend?

  • A. Psychoanalytic group
  • B. Psychoeducational group
  • C. Individual counseling
  • D. Family therapy
Correct Answer: B

Rationale: The correct answer is B: Psychoeducational group. This option is most beneficial as it provides education and information to the family about the patient's illness, treatment options, and ways they can support his recovery. It helps them understand the challenges the patient faces and equips them with practical strategies to assist in his recovery process.

A: Psychoanalytic group focuses on exploring unconscious patterns of behavior and may not provide the necessary education and tools for the family to support the patient effectively.

C: Individual counseling is focused on the patient and may not involve the family members in understanding the illness and their role in the patient's recovery.

D: Family therapy involves the whole family in therapy sessions, but may not specifically focus on educating them about schizophrenia and its treatment, which is crucial for their support.

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An Arab student new to an elementary school reports, 'I just don't want to go to gym class.' Which factor would be of primary concern for a school nurse?

  • A. The student's family's cultural beliefs regarding females interacting with males in public
  • B. Complaints from others of 'bullying' that occurs in gym class
  • C. The student's problems adjusting to the new school environment
  • D. A teacher's concern that the gym class is overcrowded
Correct Answer: B

Rationale: The correct answer is B because the primary concern for the school nurse would be addressing any potential bullying the Arab student is experiencing in gym class. This is important for the student's well-being and mental health. Choice A is not the primary concern as it does not directly address the student's reluctance to attend gym class. Choice C focuses on general adjustment issues, while choice D pertains to a logistical issue rather than the student's emotional or social well-being. Addressing bullying is crucial to creating a safe and inclusive environment for the student.

A patient with schizophrenia has received typical (first-generation) antipsychotics for a year. His hallucinations are less intrusive, but he remains apathetic, has poverty of thought, cannot work, and is socially isolated. To address these symptoms, the nurse might consult the prescribing health care provider to suggest a change to:

  • A. Haloperidol (Haldol).
  • B. Olanzapine (Zyprexa).
  • C. Diphenhydramine (Benadryl).
  • D. Chlorpromazine (Thorazine).
Correct Answer: B

Rationale: The correct answer is B: Olanzapine (Zyprexa). Olanzapine is an atypical (second-generation) antipsychotic that has been shown to effectively target negative symptoms of schizophrenia, such as apathy, poverty of thought, and social isolation. It also helps with mood stabilization and cognitive function, which can improve the patient's ability to work and engage in social interactions.

Choice A: Haloperidol (Haldol) is a typical (first-generation) antipsychotic like the current medication, which is less effective in treating negative symptoms and can potentially worsen them.

Choice C: Diphenhydramine (Benadryl) is an antihistamine and not indicated for treating schizophrenia symptoms.

Choice D: Chlorpromazine (Thorazine) is another typical (first-generation) antipsychotic, similar to the current medication, and may not adequately address the negative symptoms the patient is experiencing.

A woman has concerns about a man she recently began to date. She confides to her friend, a nurse in the clinic, that she recently discovered that he had been charged with domestic violence in a previous relationship. She asks if this means he will also hurt her and what signs would indicate that he is likely to be abusive. What should the nurse tell her friend?

  • A. If he hasn't been abusive or controlling so far, chances are he won't be abusive later.
  • B. Abuse occurs within dysfunctional relationships, so it may not occur in your situation.
  • C. Danger signs include pathological jealousy and controlling the partner's activities.
  • D. Because you are not masochistic or provocative, it is unlikely you will be abused.
Correct Answer: C

Rationale: The correct answer is C because it provides specific warning signs of potential abuse, such as pathological jealousy and controlling behavior. These behaviors are often early indicators of an abusive relationship. Option A is incorrect as past behavior can indicate future behavior. Option B is not correct as abuse can occur in any type of relationship. Option D is also incorrect as it implies that abuse is the fault of the victim, which is not true. It is important to educate the woman on recognizing red flags and seeking help if needed.

A patient with schizophrenia repeatedly asks for directions and the time of day. The nurse should:

  • A. repeat the information in a kind, matter-of-fact manner.
  • B. write out the information so the patient can easily refer to it.
  • C. tell the patient that the habit of frequent questioning is annoying.
  • D. provide the information once and then remind the patient that the question was already asked.
Correct Answer: A

Rationale: The correct answer is A because patients with schizophrenia may have cognitive impairments affecting memory and orientation, leading to repetitive questioning. By repeating information in a kind, matter-of-fact manner, the nurse can address the patient's needs without causing distress.

Choice B may be helpful, but verbal reinforcement is essential for immediate clarification. Choice C is incorrect as it may exacerbate the patient's distress and worsen the therapeutic relationship. Choice D does not address the underlying cognitive issue and may come across as dismissive.

The distinction between obsessions and compulsions is the distinction between

  • A. engaging in behaviors that are merely inconvenient and those that are severely disruptive
  • B. having positive and negative feelings toward an object or event
  • C. thoughts that are evidence of neurosis or those that are evidence of psychosis
  • D. having repetitious thoughts or engaging in repetitious actions
Correct Answer: D

Rationale: Obsessions are intrusive thoughts, while compulsions are repetitive actions to relieve them.

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