Population Specific Care

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A patient with schizophrenia is admitted to the psychiatric unit in an acutely disturbed, violent state. He is given several doses of haloperidol (Haldol) and becomes calm and approachable. During rounds the nurse notices the patient has his head rotated to one side in a stiffly fixed position. His lower jaw is thrust forward and he appears severely anxious. The patient has _____, and the nurse should _____.

  • A. A dystonic reaction"¦administer PRN IM benztropine (Cogentin)
  • B. Tardive dyskinesia"¦seek a change in the drug or its dosage
  • C. Waxy flexibility"¦continue treatment with antipsychotic drugs
  • D. Akathisia"¦administer PRN diphenhydramine (Benadryl) PO
Correct Answer: A

Rationale: The correct answer is A: A dystonic reaction"¦administer PRN IM benztropine (Cogentin). This patient is exhibiting symptoms of acute dystonia, a extrapyramidal side effect of haloperidol. Dystonic reactions are characterized by sustained muscle contractions causing abnormal postures. Benztropine is an anticholinergic medication that helps alleviate these symptoms by blocking the neurotransmitter acetylcholine. Administering benztropine is the appropriate treatment for acute dystonia.

Summary of other choices:
B: Tardive dyskinesia"¦seek a change in the drug or its dosage - Tardive dyskinesia is a side effect that occurs after long-term antipsychotic use, not acutely like in this case.
C: Waxy flexibility"¦continue treatment with antipsychotic drugs - Waxy flexibility is a symptom of catatonia, not a side effect of antipsychotic medications

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After being raped, a woman was told by her aunt, 'I'm not surprised that happened to you. You were asking for it.' A few days later, a friend told her, 'Well after all, he took you to dinner. He expected something in return.' The victim states, 'I can't believe that people can think that way.' The rape crisis nurse correctly hypothesizes that the client is:

  • A. Experiencing cognitive dissonance.
  • B. In denial about the rape.
  • C. Seeking validation from others.
  • D. None of the above.
Correct Answer: A

Rationale: The correct answer is A: Experiencing cognitive dissonance. Cognitive dissonance refers to the mental discomfort or conflict that occurs when a person's beliefs or attitudes are inconsistent with their actions or experiences. In this scenario, the woman is facing conflicting beliefs - she knows she did not ask for or deserve to be raped, yet the comments from her aunt and friend suggest otherwise. This leads to the woman feeling disbelief and distress.

Summary:
B: In denial about the rape - This choice does not address the conflicting beliefs the woman is experiencing.
C: Seeking validation from others - While seeking validation may be a natural response, it does not capture the essence of cognitive dissonance in this context.

In refeeding syndrome that develops during nutritional rehabilitation of a patient with eating disorder, what is the most important biochemical change?

  • A. Hypomagnesemia
  • B. Hypophosphatemia
  • C. Hypokalaemia
  • D. Hypoglycaemia
Correct Answer: B

Rationale: Hypophosphatemia is the most critical biochemical change in refeeding syndrome, as it can lead to severe complications like cardiac arrest.

Which of the following should the nurse consider when planning care for a client with antisocial personality disorder? Clients with antisocial personality disorder:

  • A. Demand constant attention
  • B. Tolerate frustration well
  • C. Have well-developed superegos
  • D. Are initially often charming
Correct Answer: D

Rationale: The correct answer is D: Are initially often charming. This is because individuals with antisocial personality disorder often exhibit charm and charisma to manipulate others for personal gain. This behavior is known as "charm offensive" and can be used to deceive and exploit others. This initial charm can make it difficult for others to recognize their true motives and manipulative nature.

Incorrect options:
A: Demand constant attention - Individuals with antisocial personality disorder may appear self-centered and manipulative but not necessarily demand constant attention.
B: Tolerate frustration well - Clients with antisocial personality disorder often have difficulty managing frustration and may resort to aggressive or impulsive behavior.
C: Have well-developed superegos - Individuals with antisocial personality disorder typically lack empathy and have a weak or underdeveloped superego, leading to a disregard for social norms and the rights of others.

A patient tells the nurse, 'I can't go to any unit meetings because when I get in that room, everyone can hear my thoughts.' The nurse can correctly assess this symptom as:

  • A. concrete thinking.
  • B. loose associations.
  • C. thought broadcasting.
  • D. auditory hallucinations.
Correct Answer: C

Rationale: The correct answer is C: thought broadcasting. This is when a person believes that others can hear their thoughts. In this scenario, the patient's belief that everyone in the unit meetings can hear their thoughts aligns with the symptom of thought broadcasting. It is a common manifestation of certain psychiatric disorders like schizophrenia.

Choice A, concrete thinking, refers to literal thinking without abstract reasoning and is not applicable in this context. Choice B, loose associations, involves disorganized and illogical thought patterns, which are not evident in the patient's statement. Choice D, auditory hallucinations, refers to hearing voices when no external stimulus is present, which is different from the patient's belief that others can hear their thoughts.

An adult patient tells the case manager, 'I dont have bipolar disorder anymore, so I dont need medicine. After I was in the hospital last year, you helped me get an apartment and disability checks. Now Im bored and dont have any friends.' Where should the nurse refer the patient? Select one tha does not apply.

  • A. Psychoeducational classes
  • B. Vocational rehabilitation
  • C. Social skills training
  • D. A homeless shelter
Correct Answer: D

Rationale: The patient does not understand the illness and need for adherence to the medication regimen. Psychoeducation for the patient (and family) can address this lack of knowledge. The patient, who considers himself friendless, could also profit from social skills training to improve the quality of interpersonal relationships. Many patients with serious mental illness have such poor communication skills that others are uncomfortable interacting with them. Interactional skills can be effectively taught by breaking the skill down into smaller verbal and nonverbal components. Work gives meaning and purpose to life, so vocational rehabilitation can assist with this aspect of care. The nurse case manager will function in the role of crisis stabilizer, so no related referral is needed. The patient presently has a home and does not require a homeless shelter.

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