Age Specific Care Quiz

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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).

1. Dystonic reaction is characterized by involuntary muscle contractions, causing abnormal posture or movements.
2. The patient's symptoms of head rotation, jaw thrust, and severe anxiety align with dystonic reaction.
3. Benztropine is an anticholinergic medication used to treat dystonic reactions by blocking acetylcholine in the brain.
4. Administering benztropine promptly can alleviate the symptoms and prevent complications.

Other choices are incorrect:
B: Tardive dyskinesia develops with long-term antipsychotic use, presenting as repetitive, involuntary movements. Seeking a change in drug or dosage is not appropriate for acute dystonic reaction.
C: Waxy flexibility is a symptom of catatonia, not related to the patient's presentation of dystonic reaction.
D: Akathisia is restlessness and agitation often caused by

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A patient with the diagnosis of schizophrenia, disorganized type, approaches the nurse and says, "It's beat, it's eat. No room for doom." The nurse can correctly assess this verbalization as:

  • A. Neologisms
  • B. Clanging
  • C. Ideas of reference.
  • D. Associative looseness.
Correct Answer: B

Rationale: The correct answer is B: Clanging. Clanging refers to the association of words based on sound rather than meaning. In this case, the patient's verbalization "It's beat, it's eat. No room for doom" demonstrates a pattern of words that rhyme or have similar sounds but lack coherent meaning. This is characteristic of clanging seen in disorganized schizophrenia. Neologisms (A) are newly created words with unique meanings, which is not evident here. Ideas of reference (C) involve misinterpreting unrelated events as being personally significant, which is not demonstrated in the patient's statement. Associative looseness (D) is a thought disorder where ideas are loosely associated, but the patient's statement does not show this specific feature.

Which of the following criteria can be used to define intellectual disabilities?

  • A. Significantly below average intellectual functioning
  • B. Impairments in adaptive functioning generally
  • C. These deficits should be manifest before the age of 18 -years
  • D. All of the above
Correct Answer: D

Rationale: Intellectual Disabilities: Defined by below-average intellectual functioning, adaptive impairments, and onset before age 18.

Which nursing diagnosis is more relevant for a patient with anorexia nervosa who restricts intake and is 20% below normal weight than for a 130-pound patient with bulimia nervosa who purges?

  • A. Powerlessness
  • B. Ineffective coping
  • C. Disturbed body image
  • D. Imbalanced nutrition: less than body requirements
Correct Answer: D

Rationale: The correct answer is D, Imbalanced nutrition: less than body requirements. For a patient with anorexia nervosa who restricts intake and is 20% below normal weight, this diagnosis is more relevant as it directly addresses the issue of inadequate food intake leading to weight loss. Powerlessness (A) may not be as directly related to the physical consequences of anorexia. Ineffective coping (B) and Disturbed body image (C) are more commonly associated with bulimia nervosa and do not address the primary concern of malnutrition in this case.

A 67-year-old woman recently noticed a non-painful lump in the right breast (see image). Which one of the following is the most likely diagnosis?

  • A. Subacute mastitis with early abscess formation.
  • B. Advanced adenocarcinoma of the breast.
  • C. Early intraduct carcinoma with obstruction of ductal ampullae.
  • D. Severe fibrocystic disease of the breast (fibroadenosis with multiple cysts).
Correct Answer: B

Rationale: A non-painful breast lump in a 67-year-old is most likely advanced adenocarcinoma (B), a common malignancy in this age group. Mastitis (A) is painful, early carcinoma (C) less likely advanced, and fibrocystic disease (D) or fat necrosis (E) are less typical without specific trauma or cysts.

A patient diagnosed with schizophrenia has been rehospitalized after a relapse. A priority intervention in designing a discharge plan to prevent relapses will be:

  • A. helping the patient's family develop tolerance for the cognitive symptoms.
  • B. mobilizing the family to provide structure to reduce social dysfunction.
  • C. working on self-concept to reduce abolition, anhedonia, and dysphoria.
  • D. early identification of signs of impending relapse and coping strategies.
Correct Answer: D

Rationale: The correct answer is D because early identification of signs of impending relapse and coping strategies are crucial in preventing relapses in schizophrenia. By recognizing early warning signs, the patient can receive timely intervention and support to prevent further deterioration. This proactive approach enables healthcare providers to adjust treatment plans and provide necessary resources, ultimately reducing the likelihood of rehospitalization.

Choice A is incorrect because developing tolerance for cognitive symptoms may be beneficial but not a priority in preventing relapses. Choice B is incorrect as family support is important but solely relying on family for structure may not address all factors contributing to relapse. Choice C is incorrect as working on self-concept may be helpful but not directly related to preventing relapses.

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