Population Based Care

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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.

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An emergency department nurse prepares to assist with examination of a sexual assault victim. What equipment will be needed to collect and document forensic evidence? Select all that apply.

  • A. Body map.
  • B. DNA swabs.
  • C. Photographs.
  • D. Pulse oximeter.
Correct Answer: A

Rationale: The correct answer is A: Body map. In cases of sexual assault, a body map is essential to document and track injuries and evidence. It helps in accurately recording the location and nature of injuries on the victim's body. DNA swabs and photographs are also important for collecting forensic evidence. DNA swabs can help in identifying the perpetrator, while photographs can visually document injuries and evidence. However, a pulse oximeter is not typically needed for collecting forensic evidence in cases of sexual assault. It is used to measure oxygen saturation in the blood and is not directly relevant to documenting forensic evidence in this context.

An individual accompanied by a sibling was brought by ambulance to the emergency room with suspected impaired cognitive function. The patient's aggressive behavior and attempts to get out of bed present a safety issue. The nurse should first consider:

  • A. applying four-point restraints.
  • B. using a calm tone to orient the patient.
  • C. leaving the patient alone with the sibling.
  • D. calling for security guards to hold the patient down.
Correct Answer: B

Rationale: The correct answer is B: using a calm tone to orient the patient. This is the most appropriate initial intervention because it aims to address the patient's aggressive behavior by providing reassurance and attempting to reorient them to their surroundings. Using a calm tone can help de-escalate the situation and improve communication with the patient. Applying four-point restraints (choice A) should be avoided as it is a restrictive measure that should only be used as a last resort to ensure patient safety. Leaving the patient alone with the sibling (choice C) may exacerbate the safety issue, as the sibling may not be equipped to manage the situation. Calling for security guards to hold the patient down (choice D) is a forceful approach that should be avoided until all other options have been exhausted.

A homeless individual diagnosed with serious mental illness, anosognosia, and a history of persistent treatment nonadherence is persuaded to come to the day program at a community mental health center. Which intervention should be the teams initial focus?

  • A. Teach appropriate health maintenance and prevention practices.
  • B. Educate the patient about the importance of treatment adherence.
  • C. Help the patient obtain employment in a local sheltered workshop.
  • D. Interact regularly and supportively without trying to change the patient.
Correct Answer: D

Rationale: Building trust through regular, supportive interaction (D) is the initial focus to address nonadherence and anosognosia, forming a foundation for later interventions (A, B, C).

A patient diagnosed with schizophrenia has difficulty completing tasks and seems forgetful and disinterested in unit activities. A nurse can best select successful strategies by understanding that these behaviors are due to:

  • A. a lack of self-esteem.
  • B. manipulative tendencies.
  • C. shyness and embarrassment.
  • D. problems in cognitive functioning.
Correct Answer: D

Rationale: The correct answer is D: problems in cognitive functioning. In schizophrenia, cognitive deficits are common, leading to difficulties in completing tasks, forgetfulness, and lack of interest. Understanding this helps the nurse select appropriate strategies, such as breaking tasks into smaller steps. Choice A (lack of self-esteem) is incorrect as cognitive deficits in schizophrenia are not solely related to self-esteem. Choice B (manipulative tendencies) is incorrect as these behaviors are not indicative of manipulation. Choice C (shyness and embarrassment) is incorrect as cognitive deficits in schizophrenia go beyond social anxiety.

In south and east Asia, a man may experience Koro, which is

  • A. schizophrenia
  • B. insanity
  • C. anxiety about his penis receding into his body
  • D. depression
Correct Answer: C

Rationale: Koro is a culture-bound syndrome involving intense anxiety that one's penis is retracting into the body.

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